Cochlear Implant Outcomes in Adults and Adolescents With Early-Onset Hearing Loss

Objectives: The aims of the study were to investigate (1) speech perception outcomes in people with an early-onset hearing loss (HL) who received a cochlear implant as an adolescent or adult, (2) prognostic factors associated with positive speech perception outcomes, and (3) self-report outcomes in these participants. Design: Outcomes for 38 implant recipients with a Nucleus device were investigated retrospectively. All participants were diagnosed with a bilateral HL at age <= 3 yr and were implanted at age 14 yr or older. Nineteen participants had confirmed bilateral, severe to profound HL at age <= 12 mo (prelingual); nine had confirmed bilateral, severe to profound HL at age >12 mo and <= 3 yr (perilingual); and the remaining 10 had a diagnosis of bilateral sensorineural HL at age <= 3 yr which progressed to severe to profound HL after 3 yrs of age (progressive). There were 24 females and 14 males, and the average age at implantation was 33 yr (range = 14-65 yr). Closed-set and open-set speech perception tests administered pre- and postimplant were analyzed for all participants, in addition to self-report survey measures of benefit, satisfaction, and implant usage. Results: Participants were placed into one of five hierarchic categories of speech perception performance preimplantation and at 12 mo postimplantation. The categories ranged from sound detection only (category 1) to excellent open-set speech perception (category 5). To be in category 4 or 5, the participant had to score >30% words correct on a recorded version of either the Central Institute for the Deaf Everyday Sentence Lists or the City University of New York Sentences. Before implantation, two recipients (5%) were in category 4 or 5 compared with 20 (53%) at 12 mo postimplant. Consistent with previous studies, there was large intersubject variability in speech scores. Three factors accounted for 63% of the variance on open-set sentence test scores, postimplant: mode of communication in childhood (oral versus total communication/sign), stable as opposed to progressive loss, and time without a hearing aid on the implant ear. More than 80% of survey respondents used their device >8 hr a day, and 90% reported that their ability to understand speech with visual cues was "much better" with the implant. In addition, all reported being satisfied with the device. Conclusion: These results indicate that a cochlear implant should be considered as an option for adults and adolescents with early-onset HL. The majority of participants gained benefit from the device and were satisfied with it. In addition, a substantial number gained good open-set speech perception ability, postimplant. Recipients who used oral communication in childhood, had a progressive loss, and wore a hearing aid on the implant ear up to the time of surgery were more likely to obtain better speech perception outcomes.