Related Experiment Video
Updated: Jul 4, 2025
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9
Seung Jae Lee1, Heonjeong Oh2, Kyu Ha Shin2
1Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Insights
Cochlear implantation (CI) before 9 months significantly boosts receptive language in infants with profound deafness. Early CI leads to sustained language gains, supporting earlier intervention beyond current guidelines.
Area of Science:
- Pediatric audiology
- Developmental linguistics
- Otolaryngology
Background:
- Recent FDA expansion allows cochlear implantation (CI) for infants 9 months and older, prompting debate on optimal timing.
- Pediatric CI eligibility criteria and age cut-offs are critical for maximizing language development outcomes.
- Understanding early language trajectories post-CI is essential for guiding clinical practice.
Purpose of the Study:
- To compare early language development in pediatric CI recipients implanted before 9 months versus those implanted between 9 and 12 months.
- To evaluate the impact of very early CI (<9 months) on receptive and expressive language trajectories.
- To inform clinical decisions regarding the ideal age for pediatric cochlear implantation.
Main Methods:
- Retrospective review of 98 pediatric cochlear implant recipients at a tertiary center.
- Categorization into very early (<9 months), early (9-12 months), and delayed (12-18 months) CI groups based on objective auditory and language criteria.
- Assessment of postoperative language development using the Sequenced Language Scale for Infants.
Main Results:
- The very early CI group (<9 months) demonstrated significant receptive language improvements by 3 months post-implantation.
- Receptive language in the very early CI group reached levels comparable to normal-hearing peers by 9 months and was sustained until age 2.
- Language improvements were more pronounced in receptive than expressive domains during the first two years post-CI.
Conclusions:
- Cochlear implantation before 9 months of age significantly enhances receptive language development compared to later implantation.
- Early CI benefits are sustained up to age 2, supporting the consideration of implantation earlier than current FDA guidelines.
- This study advocates for earlier CI in children with profound deafness and documented language delays, particularly those with clear etiological factors.
Objectives:
The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status.
Methods:
A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9-12 months) and delayed (CI at 12-18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles.
Results:
Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language.
Conclusion:
CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).
