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Updated: Jun 16, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Long-term reliability of pediatric cochlear implants
1Department of Human Communication Sciences and Devices, House Ear Institute, Los Angeles, California, USA.
Insights
This study introduces a method to assess pediatric cochlear implant (CI) survival rates during critical speech development. Titanium-cased CIs show higher 18-year survival than ceramic ones, suggesting better reliability for children.
Area of Science:
- Otolaryngology
- Biomedical Engineering
- Pediatric Audiology
Background:
- Pediatric cochlear implants (CIs) are crucial for speech and language development.
- Assessing long-term device reliability is essential for pediatric recipients.
- Existing survival data may not align with critical developmental timelines.
Purpose of the Study:
- To define a method for interpreting cumulative survival rates (CSR) of pediatric CIs relevant to speech development.
- To apply this method to published pediatric CI failure data.
- To compare the long-term reliability of different CI device types in children.
Main Methods:
- Analysis of published cumulative survival rate data from 2009 pediatric cochlear implant recipients.
- Extrapolation of regression functions to predict 18-year cumulative survival rates (CSR).
- Comparison of CSRs based on device casing material (titanium vs. ceramic) and implantation type (monolateral vs. bilateral).
Main Results:
- Predicted 18-year CSRs for titanium-cased CIs ranged from 0.900 to 0.988 (monolateral) and 0.810 to 0.976 (bilateral).
- Predicted 18-year CSRs for ceramic-cased CIs ranged from 0.740 to 0.944 (monolateral) and 0.548 to 0.871 (bilateral).
- Titanium-cased devices demonstrated higher predicted survival rates compared to ceramic-cased devices.
Conclusions:
- The 18-year CSR method provides a meaningful estimate of pediatric CI reliability aligned with developmental stages.
- Titanium-cased cochlear implants exhibit superior long-term performance in pediatric recipients.
- Higher failure rates in ceramic devices may be linked to increased susceptibility to head trauma and casing damage in children.
Objective:
This study defines a method of interpreting cumulative survival rate for pediatric cochlear implants (CIs) that is applicable to the time span when hearing is most critical for speech and language development. In addition, it applies this method to published data reporting pediatric device failures.
Patients:
Pediatric CI recipients for whom cumulative survival rates have been published were the patient population, consisting of 2009 recipients.
Intervention:
Pediatric cochlear implantation.
Main Outcome Measure:
The main outcome measure was cumulative survival rate (CSR), defined as the percentage of CIs that are functional, calculated as a function of time after implantation. This measure was reported for time periods from 4 to 19 years for devices made by 3 CI manufacturers.
Results:
Cumulative survival rates at 18 years were predicted by extrapolating regression functions to published data. Predicted 18-year CSRs express the likelihood that the device will function throughout child development after early implantation. Devices with titanium casing exhibited 18-year CSRs from 0.900 to 0.988 for a monolateral implants and from 0.810 to 0.976 for both bilateral implants. Devices with ceramic casings had 18-year CSRs of 0.740 to 0.944 for monolateral implants and 0.548 to 0.871 for bilateral implants.
Conclusion:
Use of 18-year CSRs allows comparison of survival rates obtained from data over different time intervals and is based on the time course of normal development. These values provide a conservative and meaningful estimate of device reliability for pediatric recipients. The higher failure rates of ceramic devices for children are likely due to the greater incidence of head trauma from impact and/or leakage from cracked casings seen in this population.
