The child's family wonders what is best for the hearing-impaired: to learn sign language or to have a cochlear implant. The latter is a thin, disc-shaped device surgically placed under the skin behind the ear. The implant employs an electrode placed in the inner ear which, when stimulated, sends signals to the brain so the person can hear.

For Dr. John Greinwald, assistant director of the Center for Hearing and Deafness Research at Cincinnati's Children's Hospital, the answer is not clear.

"It's not a black-and-white decision," he said. "It's often a combination of manual communication - sign language - and aural communication, speaking."

In the child's first year of life, he encourages "all families to use visual and spoken communication." Studies have found that both forms of communication "light up the same part of the brain."

Dr. Greinwald sees 200 hearing-impaired children a year. He annually performs "45 to 50 cochlear implant" surgeries.

Cochlear implants were approved for children in 1990. They help deaf people learn how to speak. Schools such as Montgomery's Ohio Valley Voices teach deaf children, using hearing aids and implants, how to speak and read so they can enroll in mainstream schools

With each patient, Dr. Greinwald explains the pros and cons of implants and sign language.

He begins by asking his patients' parents: "How do you want your child to interact with the world?"

To lighten the mood, he adds: "When you tell your teenager to clean his room, do you want him to talk back with sign language or give you lip?"

For information about the Center for Hearing and Deafness Research, visit www.chdr.org or call (513) 636-4356.