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Updated: Jun 19, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Revision cochlear implant surgery in children: the Johns Hopkins experience
Andrea L Marlowe1, Jill E Chinnici, Alejandro Rivas
1The Listening Center, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Insights
Revision cochlear implantation (RCI) can restore hearing in children, especially when performed due to a decline in performance. Early intervention is key, as benefits decrease with age.
Area of Science:
- Audiology
- Otolaryngology
- Biomedical Engineering
Background:
- Cochlear implantation (CI) is a vital auditory prosthesis for profound hearing loss.
- Revision cochlear implantation (RCI) addresses CI failures or suboptimal outcomes.
- Pediatric RCI efficacy requires evaluation of clinical and device factors.
Purpose of the Study:
- To evaluate the effectiveness of revision cochlear implantation (RCI) in children.
- To identify predictors of successful RCI outcomes.
Main Methods:
- Retrospective case series analysis of pediatric RCI cases.
- Correlation with ex vivo device analysis where applicable.
- Assessment of speech perception and subjective reports.
Main Results:
- 13% of pediatric CI surgeries required revision over 15 years.
- Device failure (hard or suspected) and extracochlear electrodes were primary indications.
- 84% of device failure cases regained previous performance within 18 months post-RCI.
- Younger children were more likely to achieve or exceed previous performance.
- Declining speech perception predicted better outcomes than chronic underperformance.
Conclusions:
- RCI is effective for improving auditory function in children with unfavorable CI trajectories.
- Clinical assessment and device factors guide successful RCI.
- Timely RCI positively impacts language development; delays reduce benefits.
Objective:
To assess the efficacy of revision cochlear implantation (RCI) and to identify clinical and device-related factors predictive of RCI outcome.
Study Design:
Retrospective case series with attempted correlation to ex vivo device analysis.
Setting:
Academic tertiary referral center.
Patients:
Children (<18 yr) who underwent RCI in a tertiary-care center.
Intervention:
Revision cochlear implantation with multichannel cochlear implant.
Main Outcome Measures:
Open-set speech perception testing and subjective report by child, family, teacher, or therapist; patient report of symptom resolution.
Results:
During the 15-year period, 13% of pediatric CI surgeries were revised (at an average of 3.4 yr after initial operation). Hard failures (42%), suspected device failure (29%), and extracochlear electrodes (16%) were the most common indications for RCI. Most hard and suspected device failure cases (n = 37; 84%) reported a return to previous peak performance within 18 months of RCI. Previous peak performance was more likely to be achieved or exceeded in younger than in older children. A decline in speech perception was a stronger predictor of successful outcome (100%) than chronic underperformance (57%) among children with suspected device failure. Preoperative integrity testing was only moderately predictive of functional results or findings at ex vivo device analysis.
Conclusion:
Revision cochlear implantation should be considered when longitudinal clinical assessment reveals an unfavorable trajectory in the development of receptive communication skills. Device testing provides important, but not definitive, supporting data. Revision cochlear implantation as guided by device and patient factors can exert a positive impact on access to verbal language and therefore its development. A delay to act can have lasting negative consequences because benefits seem to diminish with age.
