Safety and Effectiveness of Cochlear Implantation of Young Children, Including Those With Complicating Conditions

OBJECTIVE: Determine safety and effectiveness of cochlear implantation of children under age 37 months, including below age 12 months. STUDY DESIGN: Retrospective review. SETTING: Tertiary care children's medical center. PATIENTS: 219 children implanted before age 37 mos; 39 implanted below age 12 mos and 180 ages 12–36 mos. Mean age CI = 20.9 mos overall; 9.4 mos (5.9–11.8) and 23.4 mos (12.1–36.8) for the two age groups, respectively. All but two ≤12 mos (94.9%) received bilateral implants as did 70.5% of older group. Mean follow-up = 5.8 yrs; age last follow-up = 7.5 yrs, with no difference between groups. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: Surgical and anesthesia complications, measurable open-set speech discrimination, primary communication mode(s). RESULTS: Few surgical complications occurred, with no difference by age group. No major anesthetic morbidity occurred, with no critical events requiring intervention in the younger group while 4 older children experienced desaturations or bradycardia/hypotension. Children implanted under 12 mos developed open-set earlier (3.3 yrs vs 4.3 yrs, p ≤ 0.001) and were more likely to develop oral-only communication (88.2% vs 48.8%, p ≤ 0.001). A significant decline in rate of oral-only communication was present if implanted over 24 months, especially when comparing children with and without additional conditions associated with language delay (8.3% and 35%, respectively). CONCLUSIONS: Implantation of children under 37 months of age can be done safely, including those below age 12 mos. Implantation below 12 mos is positively associated with earlier open-set ability and oral-only communication. Children implanted after age 24 months were much less likely to use oral communication exclusively, especially those with complex medical history or additional conditions associated with language delay.