There seems to be a substantial benefit for both speech and vocabulary outcomes when children receive their implant before the age of 2.5 yr. This benefit may combine a burst of growth after implantation with the impact of increased length of use at any given age. The added advantage (i.e., burst of growth) diminishes systematically with increasing age at implantation.

The development of language and communication may play an important role in the emergence of behavioral problems in young children, but they are rarely included in predictive models of behavioral development. In this study, cross-sectional relationships between language, attention, and behavior problems were examined using parent report, videotaped observations, and performance measures in a sample of 116 severely and profoundly deaf and 69 normally hearing children ages 1.5 to 5 years. Secondary analyses were performed on data collected as part of the Childhood Development After Cochlear Implantation Study, funded by the National Institutes of Health. Hearing-impaired children showed more language, attention, and behavioral difficulties, and spent less time communicating with their parents than normally hearing children. Structural equation modeling indicated there were significant relationships between language, attention, and child behavior problems. Language was associated with behavior problems both directly and indirectly through effects on attention. Amount of parent–child communication was not related to behavior problems.

Management of implant failures and performance of revision surgery are becoming increasingly important in cochlear implant programs. Outcomes are generally excellent. Revision implantation is a safe and appropriate procedure that should be pursued in a timely fashion when patients experience cochlear implant failure.

This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. However, children in the TC group achieved significantly higher receptive spoken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementary school. Regardless of whether children were in the OC or TC group, children who received their implants during preschool demonstrated stronger performance, on average, on all measures over time than children who received their implants during their elementary school years. The results of this study suggest that children may benefit from us...