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Updated: Mar 22, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
A Systematic Review to Define the Speech and Language Benefit of Early (<12 Months) Pediatric Cochlear Implantation
Hanneke Bruijnzeel1, Fuat Ziylan, Inge Stegeman
1Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Early pediatric cochlear implantation (CI) before 12 months shows benefits in speech production, auditory performance, and receptive language. However, consistent evidence on all outcomes and the additional benefit of CI before 12 months is still lacking.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Developmental Pediatrics
Background:
- Early detection of hearing loss in infants is critical for optimal development.
- Pediatric cochlear implantation (CI) is a treatment option for severe to profound hearing loss.
- The optimal age for CI in infants remains a subject of ongoing research.
Purpose of the Study:
- To evaluate the added benefit of pediatric cochlear implantation (CI) before 12 months of age.
- To assess improvements in speech, language, and auditory development.
- To synthesize current evidence on early CI outcomes.
Main Methods:
- Systematic literature search of PubMed, EMBASE, and CINAHL databases.
- Inclusion of studies with high directness of evidence (DoE) comparing different ages at implantation.
- Assessment of speech perception, speech production, receptive language, and auditory performance.
Main Results:
- Ten high DoE studies were included; six compared infants implanted before 12 months with those implanted between 12-24 months.
- CI before 12 months showed benefits in specific speech production, auditory performance, and receptive language measures.
- Evidence was inconsistent across all speech and language outcomes regarding the benefit of implantation before 12 months.
Conclusions:
- Current evidence suggests early CI is beneficial, but lacks level 1 studies.
- The additional benefit of CI specifically before 12 months is not consistently demonstrated across all outcome measures.
- Long-term follow-up studies are needed to clarify the long-term advantages of very early pediatric CI.
Objective:
This review aimed to evaluate the additional benefit of pediatric cochlear implantation before 12 months of age considering improved speech and language development and auditory performance.
Materials And Methods:
We conducted a search in PubMed, EMBASE and CINAHL databases and included studies comparing groups with different ages at implantation and assessing speech perception and speech production, receptive language and/or auditory performance. We included studies with a high directness of evidence (DoE).
Results:
We retrieved 3,360 articles. Ten studies with a high DoE were included. Four articles with medium DoE were discussed in addition. Six studies compared infants implanted before 12 months with children implanted between 12 and 24 months. Follow-up ranged from 6 months to 9 years. Cochlear implantation before the age of 2 years is beneficial according to one speech perception score (phonetically balanced kindergarten combined with consonant-nucleus-consonant) but not on Glendonald auditory screening procedure scores. Implantation before 12 months resulted in better speech production (diagnostic evaluation of articulation and phonology and infant-toddler meaningful auditory integration scale), auditory performance (Categories of Auditory Performance-II score) and receptive language scores (2 out of 5; Preschool Language Scale combined with oral and written language skills and Peabody Picture Vocabulary Test).
Conclusions:
The current best evidence lacks level 1 evidence studies and consists mainly of cohort studies with a moderate to high risk of bias. Included studies showed consistent evidence that cochlear implantation should be performed early in life, but evidence is inconsistent on all speech and language outcome measures regarding the additional benefit of implantation before the age of 12 months. Long-term follow-up studies are necessary to provide insight on additional benefits of early pediatric cochlear implantation.
