COCHLEAR IMPLANTS: DO THEY BENEFIT CHILDREN?

Background: The purpose of a cochlear implant is to provide the recipient who has a severe-to-profound hearing loss with direct stimulation of the auditory nerve. A hearing aid, appropriate for lesser levels of hearing impairment, amplifies sound while a cochlear implant replaces a function lost by the cochlea. Cochlear implants have been in use for more than 20 years, but there is a degree of lack of awareness of the advances in the field. This includes the degree of benefit which has been obtained in children, even those born profoundly deaf. This study reports on an experience with 285 children who have received cochlear implants at our center. Methods: Since 1987 we have placed multichannel cochlear implants in 285 children ranging in age from 14 months to 17 years. These children were all evaluated using a battery of age-appropriate tests to determine their degree of hearing loss. All underwent a trial with hearing aids which demonstrated lack of significant benefit. Evaluation included parental interviews, detailed histories, evaluation for evidence of syndromal hearing loss, physical examination and high resolution CT scans of the temporal bone. These were supplemented by MRI (without Gadolinium) where necessary. Successful candidates received one of the two FDA approved multichannel cochlear implants during an operation which generally lasted approximately three hours. There were no perioperative complications and postoperative complications were minimal. The children were evaluated at 1,3,6 and 12 months post initial stimulation, and annually thereafter. Results: All children received an auditory percept when using the device. Post-lingually deaf children derived significant and immediate benefit when implanted relatively soon after losing hearing. Congenitally and pre-lingually deaf children also did very well, especially when implanted prior to the age of five years. The younger children received more immediate benefit than did those slightly older. The overwhelming majority of these children developed language and speech and were able to enter mainstream schools rather than schools for the deaf. Conclusions: The use of multichannel cochlear implants in appropriately selected deaf children as young as 14 months produces significant benefit in terms of allowing them to hear, speak, read and attend mainstream schools even when they were born deaf. A careful evaluation process, expert surgery, ongoing programming and rehabilitation are necessary in order to ensure optimal benefit. (The senior author is a member of the Medical Advisory Boards of Cochlear Corp. and the Advanced Bionics Corp.)
Neil H. Cohen, MD, FACS; Susan B. Waltzman, Ph.D; and J. Thomas Roland, Jr., MD; Department of Otolaryngology, NYU School of Medicine, New York, [...]