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Sooner is better than later for pediatric cochlear implants

Bilateral cochlear implants (CIs) placed early and simultaneously have the greatest effect on speech development in children with prelingual hearing loss.

Two retrospective studies have found that early identification, implantation as soon as is practical, and exclusive use of oral and auditory communication therapies lead to the best outcomes for language skills in children and adolescents with severe to profound sensorineural hearing loss.

One study that reviewed 25 children with bilateral CIs who were closely matched to 25 children with unilateral implants for 10 auditory, child, and environmental factors found that the children who received bilateral implantation performed significantly better in both receptive and expressive language tests than the children with unilateral implants. All the children were prelingually deaf and had received CIs before age 5 years.

Researchers also found that children who received bilateral CIs at the same time had higher scores on spoken language tests than did children undergoing 2 sequential implants, and the children with shorter intervals between implantations had better outcomes.

A second study of unilateral CI in adolescents aged 10 to 17 years with prelingual hearing loss (mean length of deafness, 11.5 years; mean age at implantation, 12.9 years) found that these children showed significant improvement in objective hearing measures in the first year after implantation. Patients who received a CI at an earlier age and who used oral communication rather than manual communication before receiving the implant performed significantly better than their age-matched peers.

Cochlear implants have become a standard treatment for children with sensorineural hearing loss. The electronic device, when surgically inserted under the skin, directly stimulates the auditory nerve to send signals to the brain, which recognizes the signals as sound. When combined with therapy, CIs help young children acquire speech, language, and social skills.

Children experience a low failure rate for cochlear implantation. Only 3% of children who received CIs over a 20-year period at 1 tertiary pediatric hospital needed reimplantation because the devices failed, and one-fifth of the failures occurred in children who had had meningitis before implantation.

The US Food and Drug Administration approved a minimum age of 12 months for pediatric CIs in 2000.

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