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Paediatric cochlear implantation: prosthetic hearing and language development
1Department of Otolaryngology, University of Iowa, Iowa City, IA 52242, USA. jay-rubenstein@uiowa.edu
Insights
Cochlear implantation in children under two years old is safe and effective, leading to comparable speech perception outcomes to older children. Early implantation supports better language and speech development in prelingually deafened children.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Speech-Language Pathology
Background:
- Cochlear implantation provides hearing benefits but is controversial for prelingually deaf children due to diagnostic, safety, and management concerns.
- Implantation in children under 2 years may pose higher surgical risks and management challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of cochlear implantation in children under 2 years old.
- To compare speech perception outcomes in early-implanted children with those implanted at older ages.
Main Methods:
- Review of surgical series and outcomes in children under 2 years old at the time of cochlear implantation.
- Assessment of auditory behaviors using tools like the Listening Progress Profile and Categories of Auditory Performance.
Main Results:
- Satisfactory perioperative and postoperative surgical outcomes were observed in children implanted under age 2.
- Significant improvements in auditory performance were noted, with no significant differences compared to a control group implanted at ages 3-5.
- Parental observations indicate early-implanted children perform as well as later-implanted peers.
Conclusions:
- Cochlear implantation can be performed safely in children under 2 years old.
- Early cochlear implantation yields speech perception results comparable to later implantation.
- Early implantation facilitates improved speech reception, language acquisition, and reading comprehension in prelingually deaf children.
Context:
Cochlear implantation offers hearing and vocational benefits to children and adults who lose their hearing after acquiring speech and language. But such implantations in prelingually deaf children are controversial, with concerns about diagnosis in very young children, safety, and durability. Implantation of children under age 2 years is potentially associated with higher surgical and anaesthesia risks, and with more challenging preoperative and postoperative management.
Starting Point:
Although only a small number of children implanted before age 2 have sufficient maturity and implant experience to undergo adult-type speech recognition tests, surgical series show that these children may be implanted safely and that their subsequent speech perception is at least as good as children implanted at an older age. The Nottingham, UK, group recently reported on a consecutive sample of 12 children aged under 2 years at implantation (Arch Otolaryngol Head Neck Surg 2002; 128: 11-14). S S Hehar and colleagues show satisfactory perioperative and postoperative surgical outcomes. 2 years after the implantation, mean scores on the Listening Progress Profile had increased from 1 to 42. Median scores of Categories of Auditory Performance increased from 0 to 5. There were no significant differences compared with a historical control group of deaf children implanted at ages 3-5. WHERE NEXT? Early results from parental observation of auditory behaviours show that children who receive a cochlear implant at an early age perform at least as well as those implanted later. These data, combined with more rigorous speech recognition results in older children, merit a gradual reduction in the age of implantation, although the uncertainties inherent in audiometric assessment and measurement of hearing-aid benefit in infants must be borne in mind. Cochlear implants in prelingually deafened children permit improved development of speech reception, language acquisition, and reading comprehension.
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