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Pediatric Cochlear Implantation: Why Do Children Receive Implants Late?
Elizabeth M Fitzpatrick1, Julia Ham, JoAnne Whittingham
11Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; 2Child Hearing Lab, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; and 3School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.
Insights
Many children receive cochlear implants later than recommended due to progressive hearing loss or complex medical needs. Continued monitoring is crucial for timely intervention in pediatric hearing loss.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Developmental Pediatrics
Background:
- Universal newborn hearing screening has increased early identification of hearing loss in children.
- Cochlear implantation is a key intervention for severe to profound hearing loss unresponsive to acoustic aids.
- Trends indicate earlier cochlear implantation, yet factors influencing delayed procedures require examination.
Purpose of the Study:
- To analyze the age and timing of cochlear implantation in children.
- To identify factors contributing to delayed cochlear implantation beyond 12 months post-diagnosis.
Main Methods:
- Population-based study of 187 children undergoing cochlear implantation (2002-2013) in Canada.
- Prospective collection of clinical data and retrospective chart review for audiologic and medical details.
- Analysis focused on children implanted >12 months after hearing loss confirmation.
Main Results:
- Median age at diagnosis was 12.6 months; median implantation age was 36.2 months.
- 63.1% of children received implants more than 12 months after hearing loss confirmation.
- Primary reasons for delay included progressive hearing loss (52.5%) and complex medical conditions (16.9%).
Conclusions:
- A significant proportion of children experience delayed cochlear implantation, often due to not meeting audiological criteria at diagnosis.
- Progressive hearing loss and complex health issues are key factors in delayed cochlear implant candidacy.
- Ongoing monitoring of children with permanent hearing loss is essential to ensure timely and appropriate cochlear implant intervention.
Objectives:
Early cochlear implantation has been widely promoted for children who derive inadequate benefit from conventional acoustic amplification. Universal newborn hearing screening has led to earlier identification and intervention, including cochlear implantation in much of the world. The purpose of this study was to examine age and time to cochlear implantation and to understand the factors that affected late cochlear implantation in children who received cochlear implants.
Design:
In this population-based study, data were examined for all children who underwent cochlear implant surgery in one region of Canada from 2002 to 2013. Clinical characteristics were collected prospectively as part of a larger project examining outcomes from newborn hearing screening. For this study, audiologic details including age and severity of hearing loss at diagnosis, age at cochlear implant candidacy, and age at cochlear implantation were documented. Additional detailed medical chart information was extracted to identify the factors associated with late implantation for children who received cochlear implants more than 12 months after confirmation of hearing loss.
Results:
The median age of diagnosis of permanent hearing loss for 187 children was 12.6 (interquartile range: 5.5, 21.7) months, and the age of cochlear implantation over the 12-year period was highly variable with a median age of 36.2 (interquartile range: 21.4, 71.3) months. A total of 118 (63.1%) received their first implant more than 12 months after confirmation of hearing loss. Detailed analysis of clinical profiles for these 118 children revealed that late implantation could be accounted for primarily by progressive hearing loss (52.5%), complex medical conditions (16.9%), family indecision (9.3%), geographical location (5.9%), and other miscellaneous known (6.8%) and unknown factors (8.5%).
Conclusions:
This study confirms that despite the trend toward earlier implantation, a substantial number of children can be expected to receive their first cochlear implant well beyond their first birthday because they do not meet audiologic criteria of severe to profound hearing loss for cochlear implantation at the time of identification of permanent hearing loss. This study underscores the importance of carefully monitoring all children with permanent hearing loss to ensure that optimal intervention including cochlear implantation occurs in a timely manner.
