Communication Development in Children Who Receive the Cochlear Implant Younger than 12 Months: Risks versus Benefits

Abstract

BACKGROUND: The advent of universal neonatal hearing screening in some countries and the availability of screening programs for at-risk infants in other countries has facilitated earlier referral, diagnosis, and intervention for infants with hearing loss. Improvements in device technology, two decades of pediatric clinical experience, a growing recognition of the efficacy of cochlear implants for young children, and the recent change in the U.S. Food and Drug Administration's age criteria to include children as young as 12 mo has led to increasing numbers of young children receiving cochlear implants. Evidence to support provision for infants younger than 12 mo is extrapolated from physiological studies, studies of children using hearing aids, and studies of children older than 12 mo of age with implants. To date, however, there are few published research findings regarding communication development in children between 6 and 12 mo of age who receive implants. The current study hypothesized that earlier implantation would lead to increased rates of language acquisition as the children were still in the critical period for their development. METHOD: A retrospective review was completed for 19 infants (mean age at implantation, 0.88 yr; range, 0.61-1.07, SD 0.15) and 87 toddlers (mean age at implantation, 1.60 yr; range, 1.13-2.00, SD 0.24) who received the multichannel implant in Melbourne, Australia. Preimplantation audiological assessments for these children included aided and unaided audiograms, auditory brain stem response, auditory steady state response (ASSR), and otoacoustic emission and indicated profound to total bilateral hearing loss in all cases. Communication assessment included completion of the Rossetti Infant-Toddler Language Scale and educational psychologists' cognitive and motor assessment. Computed tomography scan, magnetic resonance imaging, and surgical records for all cases were reviewed. Postimplantation language assessments were reported in terms of the rate of growth over time on the language comprehension and language expression subscales of the Rossetti Infant-Toddler Language Scale. RESULTS: Results demonstrated that cochlear implantation may be performed safely in very young children with excellent language outcomes. The mean rates of receptive (1.12) and expressive (1.01) language growth for children receiving implants before the age of 12 mo were significantly greater than the rates achieved by children receiving implants between 12 and 24 mo, and matched growth rates achieved by normally hearing peers. These preliminary results support the provision of cochlear implants for children younger than 12 mo of age within experienced pediatric implantation centers.