Cochlear Implantation in Infants: Why and How

Abstract

In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.

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

“…Nicholas et al also analyzed vocabulary, expressive and receptive language at 4.5 years of age and showed that children implanted between 6 and 11 months ( n = 27) achieved higher scores on all measures compared to those implanted between 12 and 18 months ( n = 42) [ 39 ]. Numerous studies demonstrated similar results regarding improved language trajectories among infants implanted <12 months [ 27 , 38 , 40 , 41 , 42 , 43 ]. However, Leigh et al showed no significant difference in the rate of receptive language growth between children implanted <12 months compared to those implanted between 13 and 24 months [ 44 ].…”

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants–not just cochlear implant-specific benefits–Perspective

“…There is consensus that cochlear implants are largely safe across all age groups with congenital and acquired hearing loss, even for very young children ( Rajan et al, 2018 ; Uecker et al, 2019 ; Sharma et al, 2020 ; Deep et al, 2021 ; Naik et al, 2021 ; Purcell et al, 2021 ). The survival rates for cochlear implants are as follows [ Lane et al (2019) : 10-year cumulative survival rates 97.2%; Chen et al (2022) : 10-year rate 96.8%, 20-year rate 96.7%].…”

“…Numerous studies indicate that children and adolescents with congenital or early onset severe and profound hearing loss benefit from CI: it provides a clear benefit in the development of brain regions associated with hearing ( Sharma et al, 2002 ; Kral and Sharma, 2012 ; Kral et al, 2016 ; Cardon and Sharma, 2019 ; Lee et al, 2020 ; Wang et al, 2021 ) and supports auditory development ( Purcell et al, 2021 ) as well as the development of spoken language ( Percy-Smith et al, 2008 ; Peters et al, 2010 ; Geers et al, 2016 ). In particular, very early implantation ( Dettman et al, 2016 ; Ruben, 2018 ; Sharma et al, 2020 ; Naik et al, 2021 ) and bilateral implantations ( Lieu et al, 2020 ; Sharma et al, 2020 ) benefit the development of verbal language.…”

Unraveling the impact of congenital deafness on individual brain organization

“…In terms of auditory recovery, hearing aids and cochlear implantation are the main options in auditory rehabilitation. In congenital hearing loss, cochlear implants should be applied in younger, rather than older children, as prognosis for effective cochlear implant decreases over time (Karltorp et al, 2020;Kral & Sharma, 2012;Lyness et al, 2013;Purcell et al, 2021;Sharma & Campbell, 2011). However, even then, the success of their application might be dependent on the level of the reorganization of the AC: an early work showed that in children prior to cochlear implantation the level of metabolism in their cortex, including the AC, predicted their speech perception outcomes (D. S. Lee et al, 2001), suggesting a challenge posed by reorganization to intact sensory restoration.…”