Cochlear implantation in the very young child: Long‐term safety and efficacy

Abstract

Cochlear implantation in children <12 months of age is safe and efficacious over an extended period of time. Rates and nature of both major and minor complications are comparable to studies in adults and older children and support continued monitoring of these patients over the long-term.

Cochlear Implantation in the Very Young Child: Issues Unique to the Under-1 Population

“…Pneumatization of the mastoid bone increases with age, approaching 60% at 2 years of age (James & Papsin, 2004). Very young children, therefore, have a greater proportion of bone marrow in their mastoid and greater risk of blood loss during mastoidectomy (Birman, 2009;James & Papsin, 2004;J. T. Roland et al, 2009, Waltzman & Roland, 2005.…”

“…Unlike older children, the facial nerve and the semicircular canals are laterally or superficially displaced, especially in the region of the underdeveloped mastoid tip where the facial nerve may lie just deep to the skin (Birman, 2009;J. T. Roland et al, 2009;Roland & Waltzman, 2005).…”

“…Attention to receiver/stimulator fixation and flap thickness is also important to the under-1 population. In very young children, the posterior scalp flap is typically thinner and more delicate, necessitating constant care and atraumatic handling of the skin flap and soft tissues (N. L. Cohen & Roland, 2006;J. T. Roland et al, 2009;Roland & Waltzman, 2005).…”

“…Opponents of this technique indicate that the device stability achieved with a tight soft tissue pocket is equivalent to that accomplished by creation of a bony well while eliminating the risks of intracranial complications (Balkany et al, 2009). Although rare dural disruption has been documented with this technique, a bony well with circumferential dural exposure has been safely drilled without complication in multiple pediatric patients, as documented in Waltzman and Roland (2005), N. L. Cohen and Roland (2006), and J. T. Roland et al (2009). Even if dural exposure is not performed, evidence suggests bony fixation with ligature tie-down is superior in the pediatric population.…”

Cochlear implantation in late childhood and adolescence: is there such a thing as ‘too late’?

“…Cochlear implantation has been found to be safe and efficacious in children below the age of 12 months, and rates of major and minor complications are equivalent to older children and adults [5,6]. In addition, these early implanted children have been shown to develop age-appropriate auditory perception and oral language skills [5].…”