Clin Exp Otorhinolaryngol.  2024 Feb;17(1):46-55. 10.21053/ceo.2024.00011.

Early Postoperative Benefits in Receptive and Expressive Language Development After Cochlear Implantation Under 9 Months of Age in Comparison to Implantation at Later Ages

• Lee SJ
• Oh H
• Shin KH
• Park SM
• Kim YK
• Jung DH
• Yang J
• Chun Y
• Kim MY
• Han JH
• Kim JA
• Tran NT
• Kim BJ
• Choi BY

• KMID: 2553055
• DOI: http://doi.org/10.21053/ceo.2024.00011

Abstract

Objectives
. The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status.
Methods
. A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9–12 months) and delayed (CI at 12–18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles.
Results
. Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language.
Conclusion
. CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).

Keyword

Cochlear Implantation; Cochlear Implants; Sensorineural Hearing Loss; Language Development; Speech Disorder

Figure

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  Fig. 1. The overall number of patients at each age at implantation. The average age at cochlear implantation (CI) of our total pediatric cohort was 12.5±7.1 months. They were divided into three subgroups: < 9 months (very early CI group), 9–12 months (early CI group), and 12–18 months group (delayed CI group).

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  Fig. 2. Correlation analysis between Sequenced Language Scale for Infants (SELSI) receptive (A) and expressive (B) scores and age at implantation within the non-cochlear nerve deficiency patients demonstrated overall negative correlations at all postoperative time points. (C) Receptive scores at 24 months of age also indicated significantly negative correlations with younger ages at the time of implantation, while expressive scores did not. Postop, postoperative; CI, cochlear implant.

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