Language and Audiological Outcomes Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: A Continuum of Benefit Associated With Cochlear Implantation at Successively Younger Ages

Abstract

Objective: To compare language and audiological outcomes among infants (<9 and <12 mo) and older children receiving cochlear implantation (CI). Study design: Retrospective chart review. Setting: Tertiary academic referral center. Patients: Pediatric patients receiving CI between October 1995 and October 2019. Intervention: Cochlear implantation Main Outcome Measures: Most recent language and audiological assessment scores were evaluated by age group. Results: A total of 118 children were studied, including 19 who were implanted <9 months of age, 19 implanted 9 to <12 months of age, and 80 implanted 12 to <36 months of age. The mean duration of follow-up was 7.4 AE 5.0 years. Most recent REEL-3 receptive (88 AE 12 vs. 73 AE 15;p ¼ 0.020) and expressive (95 AE 13 vs. 79 AE 12; p ¼ 0.013) communication scores were significantly higher in the <9 months group compared to the 9 to <12 months group. PLS and OWLS auditory comprehension and oral expression scores were significantly higher in the <12 months group compared to the 12 to <36 months group. The difference in NU-CHIPS scores between <12 and 12 to <36 months was statistically significant (89% AE 6 vs. 83% AE 12; p ¼ 0.009). LNT scores differed significantly between <9 and 9 to <12 months (94% AE 4 vs. 86% AE 10; p ¼ 0.028). Conclusions: The recent FDA expansion of pediatric CI eligibility criteria to include infants as young as 9 months of age should not serve as a strict clinical cutoff. Rather, CI can be pursued in appropriately selected younger infants to optimize language and audiological outcomes.

The Limitations of FDA Criteria: Inconsistencies with Clinical Practice, Findings, and Adult Criteria as a Barrier to Pediatric Implantation

“…9,10 CI in infants has been found to be a safe intervention under skilled providers. [11][12][13][14] Earlier age at implantation has been associated with better outcomes in numerous studies [14][15][16][17][18][19][20][21][22][23][24] and recent research has shown that implantation in younger than 9 months is advantageous when compared with those implanted between 9 and 12 months of age. 16,23,24 Dettman and colleagues purport that implantation before 9 months of age provides the best option for optimal language development.…”

“…[11][12][13][14] Earlier age at implantation has been associated with better outcomes in numerous studies [14][15][16][17][18][19][20][21][22][23][24] and recent research has shown that implantation in younger than 9 months is advantageous when compared with those implanted between 9 and 12 months of age. 16,23,24 Dettman and colleagues purport that implantation before 9 months of age provides the best option for optimal language development. 16 Previous work therefore demonstrates the safety and utility of offering surgery to families of younger children with bilateral severe to profound hearing loss, rather than waiting for a specific time frame implied by FDA criteria.…”

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 ].…”

“…Nowadays, state-of-the-art technology allows CI recipients to achieve high levels of speech understanding, enables normal social interactions, and enhances cognitive and linguistic development, which in turn significantly improves quality of life in CI recipients [ 1 , 2 ]. It is well accepted that in the pediatric population, early and consistent stimulation of the cochlea is critical for the optimal development of speech and language [ 3 , 4 ]. Hearing loss (HL), especially in young children, poses a barrier to education and social integration, as it affects language acquisition, all of which impact total score literacy and the child’s self-esteem and social skills [ 5 , 6 , 7 ].…”

“…Untreated hearing loss is often associated with academic underachievement, which can lead to reduced employment opportunities later in life [ 8 , 9 , 10 ]. 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 ].…”