Redefining Cochlear Implant Benefits to Appropriately Include Children with Additional Disabilities

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Objective:Determine safety and effectiveness of cochlear implantation of children under age 37 months, including below age 12 months.Study Design:Retrospective review.Setting:Tertiary care children's medical center.Patients:219 children implanted before age 37 mos; 39 implanted below age 12 mos and 180 ages 12–36 mos. Mean age CI = 20.9 mos overall; 9.4 mos (5.9–11.8) and 23.4 mos (12.1–36.8) for the two age groups, respectively. All but two ≤12 mos (94.9%) received bilateral implants as did 70.5% of older group. Mean follow-up = 5.8 yrs; age last follow-up = 7.5 yrs, with no difference between groups.Interventions:Cochlear implantation.Main outcome measures:Surgical and anesthesia complications, measurable open-set speech discrimination, primary communication mode(s).Results:Few surgical complications occurred, with no difference by age group. No major anesthetic morbidity occurred, with no critical events requiring intervention in the younger group while 4 older children experienced desaturations or bradycardia/hypotension. Children implanted under 12 mos developed open-set earlier (3.3 yrs vs 4.3 yrs, p ≤ 0.001) and were more likely to develop oral-only communication (88.2% vs 48.8%, p ≤ 0.001). A significant decline in rate of oral-only communication was present if implanted over 24 months, especially when comparing children with and without additional conditions associated with language delay (8.3% and 35%, respectively).Conclusions:Implantation of children under 37 months of age can be done safely, including those below age 12 mos. Implantation below 12 mos is positively associated with earlier open-set ability and oral-only communication. Children implanted after age 24 months were much less likely to use oral communication exclusively, especially those with complex medical history or additional conditions associated with language delay.

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions

Hoff¹,

Ryan²,

Thomas³

et al. 2019

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“…The opportunity to hear may provide implanted children who have complicating conditions such as ASD with a range of benefits, especially if implantation is done early in life and coupled with necessary behavioral therapy to support auditory skill and language development (7). No methods exist to accurately predict future cognitive ability and language of young children with or without ASD, including those with normal hearing.…”

Section: Discussionmentioning

confidence: 99%

“…The number of children diagnosed with ASD has increased over the past two decades, with recent studies estimating a prevalence of 1 in 88 children in the United States and 1 in 161 children worldwide (5,6). The reason for an increased rate of co-occurrence of SNHL and ASD is unknown, although developmental insults affecting both neurocognitive and auditory development have been theorized (3,7).…”

mentioning

confidence: 99%

“…CI has been demonstrated to increase the rate of both spoken and sign language acquisition for children in oral and total communication classrooms (8). In addition, for children unable to develop receptive and expressive language, CI may improve child-caregiver engagement, thereby positively influencing quality of life (7). Understanding the range of outcomes of implanted children with ASD is important for counseling of parents and professionals, including educators, to ensure that implanted children with ASD receive appropriate support and educational services.…”

mentioning

confidence: 99%

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Cochlear Implantation Can Improve Auditory Skills, Language and Social Engagement of Children With Autism Spectrum Disorder

Jenks

Hoff

Haney

et al. 2021

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Objective: To review outcomes of cochlear implantation (CI) in children diagnosed with autism spectrum disorder (ASD). Study Design: Retrospective case review and parent survey. Setting: Tertiary care children's hospital. Patients: Thirty children with ASD who underwent CI between 1991 and 2018. Mean age at CI ¼ 3.5 years (0.8-11.8), mean age at diagnosis of ASD ¼ 5.1 years (2.0-15.0) (22/30 diagnosed after CI), mean follow-up ¼ 10.5 years (1.4-21.6). Parents of 7 children returned a survey. Intervention: Unilateral or bilateral cochlear implantation. Main Outcome Measures: Speech perception; expressive communication mode; educational placement; social engagement; consistency of CI use; parent survey of child behavior change. Results: Thirty-three percent of all and 45% of the 22 consistent device users developed measurable open-set speech perception by an average of 4.5 years of device use.Educational placement at last follow-up included 13% mainstreamed without interpreter, 50% Special Education programs, 10% therapeutic residential or day programs, 23% total communication programs, and one home schooled. Spoken language alone was used by 31% and spoken plus sign by 14%, with the remainder using sign alone, augmentative communication devices or no mode of communication. By parent report, 86% showed improvement in social engagement compared to pre-CI. Survey results showed the behaviors most frequently ranked as most affected by CI were communication and attention, while awareness of environment had the lowest (most affected) mean ranking. Conclusions: Findings support a growing body of literature that cochlear implantation has the potential to improve auditory skills, language, and enhance social engagement in some deaf children with autism spectrum disorder.

Outcomes and Time to Emergence of Auditory Skills After Cochlear Implantation of Children With Charge Syndrome

Young

Tournis²,

Sandy³

et al. 2017