Younger Age at Cochlear Implant Activation Results in Improved Auditory Skill Development for Children With Congenital Deafness

Abstract

Purpose: The U.S. Food and Drug Administration indications for cochlear implantation in children is currently 9 months of age and older for children with bilateral profound sensorineural hearing loss (SNHL). Studies have shown that earlier activation of a cochlear implant (CI) can lead to better spoken language outcomes. As auditory skills are a precursor to the development of spoken language, this study was developed to investigate the influence of age at CI activation on auditory skill acquisition in young children. A secondary aim was to describe the auditory skills of children implanted prior to 9 months of age as compared to children with older ages of activation. Method: Functional Listening Index (FLI) scores obtained during routine clinical visits were reviewed for 78 pediatric CI recipients with congenital bilateral profound hearing loss who were activated before 2 years of age. A linear mixed-effects model assessed the effect of age at CI activation on cumulative FLI scores over time. Results: There was a significant interaction between age at activation and chronological age at the time of evaluation, indicating that children with earlier access to sound achieved a greater number of auditory skills than those with later CI activations when measured at the same chronological age. Children activated before the age of 9 months approximated scores expected of children with typical hearing, whereas children activated between 9 and 24 months of age did not. Conclusions: Younger age at CI activation is associated with increased auditory skills over time. Children who undergo cochlear implantation and CI activation before 9 months achieve more auditory skills by 4 years of age than children who are activated at later ages. These data suggest that reducing the approved age at cochlear implantation for children with congenital bilateral profound SNHL may support optimal auditory skill acquisition.

Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9 Months of Age in Comparison to Implantation at Later Ages

“…Consistent with our findings, Culbertson et al [ 10 ] demonstrated that implantees under 9 months of age rapidly improve in auditory skills postoperatively. By the age of 2 years, these children matched the auditory skills of their normal-hearing peers and continued to outperform those implanted later, at least until the age of 4 [ 10 ].…”

“…Second, it is unclear whether the benefits of very early CI are immediately apparent, even within the first year following the procedure, in terms of receptive and expressive language development. Although children who received their implants and activation before 9 months of age have been reported to exhibit rapid auditory skill development, reaching the expected performance level of normal-hearing peers by the age of 2 [ 10 ], the early trajectory of receptive and expressive language development in the first 1–2 years post-implantation for the under-9-months group—which could reflect the direct impact of CI without confounding factors—compared to long-term outcomes, remains largely unexplored.…”

Cochlear Implantation in Children Under 9 Months of Age: Safety and Efficacy

“…Preliminary studies comparing speech perception in patients under 9 months of age are small; however, they do show promising results. Culbertson et al (39) demonstrated improved auditory skills by 4 years of age in children implanted before 9 months of age, compared with those activated at a later age.…”

Indikationen zur Cochlea-Implantat Versorgung bei Kindern: Wohin geht die Reise?

“…1. Nach derzeitigem Wissensstand sollte die Versorgung von Kindern mit kongenitaler, an Taubheit grenzender Schwerhörigkeit bis Taubheit mit einem oder zwei CI frühestmöglich nach Abschluss der pädaudiologischen Bestätigungsdiagnostik nach auffälligem Neugeborenen-Hörscreening erfolgen [4,5,6]. Voraussetzung ist, dass die Ergebnisse der frequenzspezifischen, objektiven Diagnostik verlässlich sind und in Zusammenschau mit altersangepassten, subjektiven Tests hinsichtlich ihrer Plausibilität überprüft werden sowie soziofamiliäre Aspekte berücksichtigt werden.…”