Hidden disabilities and cochlear implantation under 12 months of age
Reviewed by Kerri Millward & Morag Lockley

There has been a global shift to providing children with severe-profound deafness cochlear implants (CIs) before they are 12 months old. Early intervention is critical and one of the overriding factors in successful outcomes for children with CIs. Early implantation has therefore led to children being implanted before it is clear if they have additional disabilities, which may also impact on the child’s outcome with their CI. This can make it difficult to counsel parents about outcomes. A centre in New York, which typically implants children at nine months of age, retrospectively looked at 108 children implanted before they were 12 months. They were divided into three groups: those that had no additional disabilities, those that had additional difficulties diagnosed after they had undergone implantation, and those that had additional disabilities identified before implantation. The three groups were compared on language and speech testing measures. They found that those with additional difficulties generally did poorer on these measures than children with no additional difficulties. However, children that had additional difficulties still benefited from early invention with their CIs. Less than 10% had additional diagnosis after implantation and most disorders were neurocognitive or learning difficulties which were diagnosed many years after the CI surgery. This is just too long to wait and would lead to a substantial negative effect on the outcomes with the CI. Therefore implantation should not be delayed to establish if children have additional difficulties, as the negative impact of delaying implantation on their speech and listening development outweighs the benefit that may be achieved in waiting for a diagnosis of additional disabilities. Preop expectations counselling regarding ‘hidden’ disabilities potentially appearing later may be recommended.

Cochlear implantation in children under 12 months: Prevalence and implications of ‘hidden’ disabilities.
Friedmann DR, Tona KM, Roland Jr T, et al.
COCHLEAR IMPLANTS INTERNATIONAL
2020;21(6)307-12.