Rapid ReviewPaediatric cochlear implantation: prosthetic hearing and language development
Section snippets
Speech recognition
Open-set monosyllabic word-recognition is the most difficult test of speech recognition and is now the standard for reporting outcomes in implanted adults. Such tests exist for children, although there are questions about the age-appropriateness of test materials.5 The best measure for prelingually-deafened children is open-set monosyllabic word scores after sufficient implant experience and chronological age have accrued. In 34 prelingually deaf recipients of implants, phonetically-balanced
Language development
The ability of cochlear implants to serve as a physiological substrate for language development in children has been sharply questioned. Tomblin et al13 administered two tests of language achievement to 29 prelingually deaf children with at least 3 years of implant experience compared with comparably deaf children without implants. The implant recipients showed significant gains that progressively widened over 5 years of implant experience.
Similar results with a different test of English
Reading development
It has been said that prelingually deaf children routinely do not exceed a fourth-grade reading level.16 Enhancement of reading skills is arguably the single greatest achievement possible with a cochlear implant in a prelingually deaf child. 40 such children using measures of reading comprehension showed substantial gains compared with historical controls.17 The implanted children exceeded the fourth-grade barrier, and their reading-grade quotient (grade level achieved on test divided by years
Discussion
The best age for cochlear implantation in prelingually deaf children has been controversial since the practice began. Basic neuroscience suggests critical periods of development for all sensory systems and subsequently for speech and language.20 Thus the potential benefit of earlier implantation is to be expected. There is no surgical barrier to the implantation of infants and small children, although the procedure is technically more challenging in this group. The main concerns were about
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