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Updated: May 3, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Safety and functional results of early cochlear implant switch-on in children
Pasquale Marsella1, Alessandro Scorpecci, Concettina Pacifico
1Audiology-Otology Unit and Cochlear Implant Tertiary Care Center, ENT Department of the "Bambino Gesù" Paediatric Hospital and Scientific Research Institute, Vatican City, Rome, Italy.
Insights
Early cochlear implant activation in children is safe and well-tolerated, showing no complications. While not statistically significant, early switch-on may lead to more stable impedances compared to traditional activation.
Area of Science:
- Pediatric Otolaryngology
- Auditory Implants
- Neuroscience
Background:
- Cochlear implantation is a critical intervention for pediatric hearing loss.
- Traditional cochlear implant activation occurs at 4 weeks post-surgery.
- The potential benefits and safety of earlier activation remain under investigation.
Purpose of the Study:
- To evaluate the safety and advantages of early (1-week) cochlear implant switch-on in children.
- To compare impedance and electrically evoked compound action potential (ECAP) thresholds between early and traditional (4-week) switch-on groups.
Main Methods:
- Prospective cohort study involving 17 children (20 ears) with Nucleus Freedom cochlear implants.
- Ten ears underwent early (1-week) switch-on, and 10 underwent traditional (4-week) switch-on.
- Impedance and ECAP thresholds were monitored from surgery to 9 months; speech perception was also assessed.
Main Results:
- Early switch-on was safe and well-tolerated in pediatric patients, with no reported complications.
- Both groups showed significant impedance drops post-activation, with a trend towards earlier stability in the early group (not statistically significant).
- Electrically evoked compound action potential thresholds and speech perception improvements were similar between the early and traditional switch-on groups.
Conclusions:
- Early cochlear implant switch-on (1 week) is a safe procedure for children, comparable to the traditional 4-week protocol.
- Early activation may offer benefits of lower and more stable impedances, warranting further investigation.
- This study provides initial evidence supporting the feasibility and potential advantages of early pediatric cochlear implant activation.
Objective:
To assess the safety and the possible advantages of early (1-wk) cochlear implant switch-on in children and to compare impedance and ECAP threshold changes between subjects undergoing early switch-on and those undergoing traditional, 1-month switch-on.
Study Design:
Prospective cohort study.
Setting:
Tertiary care referral pediatric center.
Patients:
Seventeen children receiving a unilateral or bilateral Nucleus Freedom cochlear implant were included, for a total of 20 ears. Ten ears were assigned to the early (1-wk) switch-on group and 10 to the control group (switch-on after 4 wks).
Interventions:
Common ground impedance values and electrically evoked compound action potential thresholds were measured from intraoperation until 9 months postoperatively. Speech perception improvements over time were also assessed.
Main Outcome Measures:
Complication rate, impedance levels (kΩ), and electrically evoked compound action potentials (current levels)
Results:
Early switch-on was well tolerated by patients and did not cause complications. Impedances dropped significantly after switch-on in both groups. They also seemed to achieve an earlier stability in the early switch-on patients, although the difference between groups was not significant. ECAP thresholds showed a similar, nonsignificant decreasing trend over time in both groups. Speech perception improvements did not differ between groups.
Conclusion:
This is the first study investigating the safety and the effects of an early cochlear implant switch-on in children. Results show that such a procedure is well tolerated by pediatric subjects and free from complications. Impedance measurements suggest that the earlier switched-on subjects benefit of lower and more stable impedances than subjects undergoing 1-month switch-on.
