Long-term follow up of infants (4-11 months) fitted with cochlear implants

The aim of the present study was to investigate the efficacy of cochlear implants (CIs) in infants who were implanted at < 11 months of age versus children operated at later age (i.e. 12-36 months) and to document whether children who receive a CI below 11 months of age are able to achieve age-appropriate expected spoken language skills, at a follow-up time from 4 to 9 years. From November 1998 to November 2007, 185 children received CIs and 34 received auditory brainstem implants in our department. The present study focuses on 13 children implanted at ages younger than 12 months (4-11 months; mean, 8.2; SD = 2.4) and fitted with CIs between November 1998 and March 2004. To avoid bias these children were selected from a larger longitudinal cohort of pediatric CI recipients fitted with CIs because they all were implanted with the same cochlear device (Nucleus CI 24 M) during the same period. Postoperatively auditory abilities were evaluated at the latest follow-up, from 4 to 9 years after surgery, with CAP, PPVT-R, TROG, and SIR. The results obtained in this group of 13 children were compared with those obtained in two groups of children implanted at later ages (12-23 and 24-36 months, respectively). No complication has been observed so far. The highest score of CAP function was achieved in all the three groups but at different intervals from CI activation as function of age at CI implantation. The rate of receptive language growth (PPVT-R) provides distinctive evidence that only the scores of the first group overlap the line of normal-hearing children, whereas the second and third group never reached the values of normal peers even after 9 years of CI use. TROG outcomes clearly indicate that only children from the first group (77%) are in the 76-100 percentile at 5 years follow-up. At 9 years follow-up, 100% of children in the first group, 38% in the second group, and 20% in the third group are in the 76-100 percentile. The SIR outcomes at the 5 years follow-up indicate that none of children was identified within the first two categories, only children from the third group (18%) were identified in category 3, all infants of the first group, 80% of group 2, and 63% of the third group were identified in category 5. At the 9 years follow-up, the number of children from the third group identified in category 3 was reduced to 10%, the second and third groups displayed a slightly higher percentage of children in category 5, but the difference from the values observed at the 5-year follow-up is not significant. In this study the outcomes from several indices (Category of Auditory Performance, CAP; Peabody Picture Vocabulary Test (Revised), PPVT-R; Test of Reception of Grammar, TROG; and Speech Intellegibility Rating, SIR) in three groups of children with different ages at implantation (from 4 to 36 months) with a follow-up time from 4 to 9 years demonstrate that very early cochlear implantation (<11 months) provides normalization of audio-phonologic parameters with no complications.