Assessment of Receptive and Expressive Language Skills Among Young Children With Prelingual Single-Sided Deafness Managed With Early Cochlear Implantation

Abstract

IMPORTANCE Pediatric single-sided deafness (SSD) can seriously affect development, causing impaired spatial hearing skills, speech-language delays, and academic underachievement. Early cochlear implantation likely improves hearing-related outcomes, but its association with language development remains unclear.OBJECTIVE To investigate whether early cochlear implantation is associated with language outcomes for children with prelingual SSD. DESIGN, SETTING, AND PARTICIPANTSThe Cochlear Implant for Children and One Deaf Ear study was initiated in 2015 and recruited participants at 4 academic hospitals in Flanders, Belgium, through 2019. This cohort study included 3 groups of children aged 2 to 5 years: children with SSD and a cochlear implant, children with SSD without a cochlear implant, and a control group with normal hearing. Language and hearing skills were assessed 1 to 2 times per year until the age of 10 years.Study completion rates were high (82%). Data analysis was performed from October to December 2020. EXPOSURE Unilateral cochlear implant. MAIN OUTCOMES AND MEASURESLongitudinal vocabulary, grammar, and receptive language scores. The implanted group was hypothesized to outperform the nonimplanted group on all language tests. RESULTS During the recruitment period, 47 children with prelingual SSD without additional disabilities were identified at the participating hospitals. Fifteen of the 34 children with an intact auditory nerve received a cochlear implant (44%, convenience sample). Sixteen of the remaining children were enrolled in the SSD control group (50%). Data from 61 children (mean [SD] age at the time of enrollment, 2.08 [1.34] years; 26 girls [42%]) were included in the analysis: 15 children with SSD and a cochlear implant, 16 children with SSD without a cochlear implant, and 30 children with normal hearing. Children with SSD and a cochlear implant performed in line with their peers with normal hearing with regard to grammar. In contrast, children with SSD without a cochlear implant had worse grammar scores than the group with implants (−0.76; 95% CI, −0.31 to −1.21; P = .004) and the group with normal hearing (−0.53; 95% CI, −0.91 to −0.15; P = .02). The 3 groups had similar vocabulary and receptive language abilities. CONCLUSIONS AND RELEVANCE These findings suggest that early cochlear implantation is associated with normal grammar development in young children with prelingual SSD. Although further follow-up will reveal the long-term outcomes of the cochlear implant for other skills, the (continued) Key Points Question Is early cochlear implantation associated with language development in children with prelingual single-sided deafness (SSD)? Findings In this longitudinal cohort study of 61 children, children with SSD with a cochlear implant achieved significantly better scores for grammar than children with SSD without an implant (difference in score, 0.76), similar to scores for children with bilateral normal hearing. Vocabulary and receptive language scores did not differ for the 3 groups. Me...

Longitudinal auditory data of children with prelingual single-sided deafness managed with early cochlear implantation

“…As such, providing these children with a CI may not only affect auditory outcomes, but it could aid their neurocognitive development as well. Indeed, we demonstrated that young children with SSD who received a CI show stronger grammar skills compared to their non-implanted peers 45 . This improvement is likely due to enhanced speech perception with the CI, which may especially affect the perception of short phonemes that carry grammatical cues (e.g.…”

“…Additionally, some children were able to localize sounds with reasonable accuracy. Improved spatial hearing, in turn, may support the development of other skills like grammar development 45 . As such, early cochlear implantation may offer many benefits to children with SSD and it should be considered as standard of care.…”

“…Previously, we have shown that early cochlear implantation supports normal language development, while untreated SSD may lead to delays in language development, especially with regard to grammar 44 , 45 . In this study, we investigate the children’s spatial speech perception in noise and sound localization abilities.…”

Task force Guideline of Brazilian Society of Otology – hearing loss in children – Part II — Treatment

“…This would explain why children with SSD seem to benefit from early cochlear implantation regarding language development. 68 …”

Impact of unilateral hearing loss in early development

“…Since the 2019 Food and Drug Administration approval for cochlear implant for children ages 5 and up with SSD, many additional recent publications have significantly bolstered an evolving body of evidence revealing the effectiveness and numerous potential benefits of cochlear implant use in pediatric recipients with SSD [15 ▪▪ ,48 ▪ ,65 ▪ ,69 ▪ ,70–74]. While there is not yet uniform consensus as to the ideal age for implantation in children with SSD, an accumulating body of evidence has demonstrated that shorter duration of deafness, ranging from less than 4–7 years, is associated with greater postimplantation performance [48 ▪ ,65 ▪ ,69 ▪ ].…”