Clinical evaluation of cochlear implantation in children younger than 12 months of age

Abstract

Importance Cochlear implantation (CI) is an effective therapy for patients with severe to profound sensorineural hearing loss. It remains controversial whether children younger than 12 months of age should undergo CI. Objective To evaluate the safety and effectiveness of CI in children younger than 12 months of age. Methods We performed a retrospective study of clinical data of pediatric patients younger than 12 months of age who underwent CI and were followed up for 1 to 2 years. Patients’ developmental levels were evaluated by the Gesell score before CI. Intraoperative and postoperative complications were recorded to evaluate the safety of CI. Auditory and speech abilities were scored by the LittlEARS® auditory questionnaire (LEAQ), categories of auditory performance (CAP), speech intelligibility rating (SIR), infant‐toddler meaningful auditory integration scale (IT‐MAIS), and meaningful use of speech scale (MUSS) at 1, 2, 3, 6, 9, and 12 months after CI. The associations between clinical characteristics before CI and postoperative scores at 1 year after CI were analyzed by the linear mixed‐effects model. Results Eighty‐nine children (47 boys and 42 girls) were included in this study (mean age at CI, 9.2 ± 1.6 months). Sixteen patients were diagnosed with cochlear malformation and 16 underwent bilateral CI. No severe complications occurred in any patients. The mean developmental quotient of the Gesell score was 78.00 ± 10.03. The median LEAQ scores were 0, 5, 10, 16, 22, 26 and 30 before and at 1, 2, 3, 6, 9, and 12 months after CI, respectively. These findings implied that the LEAQ score greatly improved in the first year after CI. The overall CAP, SIR, IT‐MAIS, and MUSS scores also increased with increasing duration after CI. No significant associations were detected between clinical characteristics (age, sex, implant number, pre‐CI Gesell score, and inner ear malformation) and LEAQ outcomes at 12 months after CI. Interpretation With increasing duration after CI, auditory and speech behavior dramatically improve in young children. Our findings indicate that CI is feasible for children younger than 12 months of age.

Safety of Cochlear Implantation in Children 12 Months or Younger: Systematic Review and Meta‐analysis

“…The 18 included studies involved a total of 449 pediatric patients 12 months and younger who underwent 625 cochlear implants (Table 1). 9,12,26,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Children ranged in age from 4 to 12 months across all studies. Information regarding laterality of cochlear implantation was included in 8 of 18 (44.4%) studies reported, with 124 implants being done on a single side and 89 being done bilaterally.…”

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

“…As a further consequence, one could also assume that frequent device use goes hand in hand with high device satisfaction. Currently, most studies concerning pediatric CI users have focused on assessing auditory skills and speech including verbal language ability or communication skills but never linked outcomes with quantitative device satisfaction and possibly related device use as well as device type dependency [ 4 , 8 , 13 , 27 , 31 , 32 , 33 , 34 ].…”

“…It is widely accepted that early identification of hearing loss in children, e.g., through hearing screening programs, followed by timely and appropriate interventions can minimize developmental delays and facilitate communication, education, and social development [ 4 , 5 ]. Research suggests that children who are born deaf or acquire hearing loss very early in life and who receive appropriate interventions within six months of age are at par with their hearing peers in terms of language development by the time they reach the age of five years (in the absence of other impairments) [ 4 , 5 , 11 , 12 , 13 ]. However, surgery and CI adaptation alone do not guarantee the full benefit of its users.…”

Language outcomes after cochlear implant

“…Children with substantial congenital hearing impairment who receive cochlear implants at a younger age have better speech and language acquisition outcomes. 11 The auditory cortex has the most neural plasticity at birth, and this plasticity decreases over time. The critical period of learning and language development is within the first 3.5 years of life.…”