Speech, language, and reading skills after early cochlear implantation

Objective: To examine whether age at cochlear implantation or duration of implant use is associated with speech, language, and reading skills exhibited at age 8 to 9 years in children who underwent implantation by age 5 years. Design: Performance outcomes in speech perception, speech production, language, and reading were examined in terms of the age at which children first received a cochlear implant (2, 3, or 4 years), the age they received an updated (Spectra) processor, and the duration of use of an implant and an updated processor. Setting: Data collection was conducted at summer research camps held over 4 consecutive years to maximize the number of children available at a specific age (8-9 years). Children were tested individually by experienced examiners, and their parents and therapists provided background and educational history information. Participants: A total of 181 children from 33 different states and 5 Canadian provinces who received a cochlear implant by age 5 years were tested. A subsample of 133 children with performance IQ scores of 80 or greater and onset of deafness at birth were selected for the age-at-implantation analysis. Another subsample of 39 children with deafness acquired by age 3 years was also examined. Outcome Measures: A battery of tests of speech perception, speech production, language, and reading was administered to each child and reduced to a single factor score for each skill. Results: Correlation coefficients between age at implantation and duration of use did not reach significance for any of the outcome skills measured. Age at which the updated speech processor (Spectra) was fitted was significantly related to speech production outcome (earlier use of an updated processor was associated with greater speech intelligibility) but not to any other skill area. However, more of the children who underwent implantation at age 2 years (43%) achieved combined speech and language skills commensurate with their age-matched peers with normal hearing than did children who underwent implantation at age 4 years (16%). Furthermore, normal speech and language skills were documented in 80% of children who lost hearing after birth and who underwent implantation within a year of onset of deafness. Conclusions: For children who receive a cochlear implant between the ages of 2 and 4 years, early cochlear implantation does not ensure better speech perception, speech production, language, or reading skills. However, greater speech and language proficiency may be expected from children who exhibit normal hearing for even a brief period after birth and receive a cochlear implant shortly after losing their hearing. Further research examining the benefits of cochlear implantation before age 2 years will help families and clinicians better understand the time-sensitive nature of the decision to conduct cochlear implant surgery.