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Updated: Jul 29, 2025
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Long Term Impact of Age at Implantation on Quality-of-Life Outcomes in Cochlear Implant Recipient Children
Vishal Gaurav1, A K Mishra1, S Karmani2
1ENT Specialist and Neurotologist, Command Hospital (WC), Chandimandir, Haryana 134107 India.
Insights
Children receiving cochlear implantation (CI) before age 5 showed significantly better long-term health-related quality of life (HRQoL) outcomes. Early CI is beneficial, but older children also experience substantial HRQoL improvements.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Quality of Life Research
Background:
- Bilateral severe to profound sensorineural hearing loss (SNHL) in children necessitates interventions like cochlear implantation (CI).
- Technological advancements enable CI in younger children, raising questions about the impact of implantation age on long-term outcomes.
- Health-related quality of life (HRQoL) is a critical measure for assessing the success of CI in pediatric populations.
Purpose of the Study:
- To investigate the long-term impact of age at cochlear implantation on Health Related Quality of Life (HRQoL) in children.
- To compare HRQoL outcomes at 5 years post-implantation between children implanted at ≤5 years versus >5 years of age.
- To provide data for counseling parents regarding optimal timing for pediatric CI.
Main Methods:
- Prospective evaluation of 50 children with CI from 2011-2018 at a tertiary care center.
- Children divided into two groups: Group A (≤5 years at implantation, n=35) and Group B (>5 years at implantation, n=15).
- Long-term HRQoL assessed at 5 years post-CI using the Nijmegen Cochlear Implant Questionnaire (NCIQ) and Children with Cochlear Implants: Parental Perspectives Questionnaire (CCIPPQ) after auditory-verbal therapy.
Main Results:
- Children implanted at ≤5 years demonstrated significantly improved HRQoL outcomes at 5 years post-CI compared to those implanted at >5 years (11.7% increase in NCIQ, 11.4% in CCIPPQ, P<0.05).
- Even children implanted after 5 years of age showed substantial HRQoL enhancement, achieving over 80% of maximum possible scores.
- The study confirmed a significant positive correlation between earlier age at implantation and better long-term HRQoL outcomes.
Conclusions:
- Cochlear implantation at or before 5 years of age is associated with significantly better long-term Health Related Quality of Life outcomes.
- While early implantation is desirable, CI remains effective in improving HRQoL for children implanted after 5 years of age.
- Understanding the influence of implantation age aids in predicting outcomes and providing informed counseling for families considering CI for their children.
Abstract:
Cochlear implantation (CI) is used in management of children with bilateral severe to profound sensorineural hearing loss (SNHL). Recently, due to technological advancements, more and more infants and toddlers are undertaking the CI. The age at implantation may have an impact on CI outcomes. The primary aim of this study was to determine the long-term impact of 'age at implantation' on Health Related Quality of Life (HRQoL) outcome post-CI. In this prospective study at a tertiary care centre, we evaluated 50 CI recipient children from 2011 to 2018. Group A consisted of 35 (70%) children who received CI at less than or equal to 5 years of age and Group B with 15 (30%) children who underwent CI at more than 5 years of age. Following CI, all children received auditory-verbal therapy and thereafter we evaluated their long-term HRQoL outcomes at 5 years post-CI. Children were assessed by Nijmegen Cochlear Implant Questionnaire (NCIQ) and Children with cochlear implants: parental perspectives-questionnaire (CCIPPQ). There were significantly improved HRQoL outcomes (with an increase of 11.7% in mean NCIQ and 11.4% in mean CCIPPQ scores) at 5 years post-CI in CI recipients of age group '5 years or less' as compared to those who underwent CI at 'more than 5 years' age [P value < 0.05 for both the mean NCIQ scores and mean CCIPPQ scores respectively]. However, for children with 'more than 5 years' age at implantation, mean NCIQ and CCIPPQ scores were still more than 80% of maximum achievable NCIQ and CCIPPQ scores. In this study, CI recipient children who were implanted at less than or equal to 5 years of age were found to have significantly improved HRQoL outcomes at 5 years post-CI. Hence, it seems desirable to provide CI at an early age. However, even in children who received CI at more than 5 years of age, there was a substantial enhancement in HRQoL outcomes and CI was still effective in these children. Hence, knowledge of 'age at implantation' may provide reasonable assistance in predicting the HRQoL outcomes and optimal counseling of parents and families of CI candidates.
