Sequential pediatric bilateral cochlear implantation: The effect of time interval between implants
Section snippets
Background
The cochlear implant (CI) has drastically modified the approach to deafness allowing a normal life for persons who are born deaf or those who have become severely or profoundly deaf. Literature has given evidence of better results compared to traditional hearing aids and studies now prove that bilateral cochlear implantation (BCI) achieves better results than the unilateral one (UCI), with consequent improvement of the quality of life [1].
BCI can be carried out in two ways: two consecutive
Subject selection
A retrospective study was conducted on 27 native Italian children who underwent sequential cochlear implantation between 2000 and 2015 at the Department of Otolaryngology and Audiology ASMN-IRCCS Hospital of Reggio Emilia (Italy). All children had congenital bilateral profound sensorineural hearing loss with no benefit from conventional hearing aids. To make the study population uniform, the forms of severe hypoacusia associated with inner ear anomalies or additional disabilities are excluded.
Results
Twenty-five of all 27 participants completed the one-year follow-up protocol and they reported that bilateral CI was helpful to them in improving life listening situations.
Data measured by bisyllabic word lists in quiet condition are shown in Table 2 and Table 3.
Table 2 shows the results with the second implant alone vs results with the first implant alone, dividing the cases into three groups according to the duration of the inter-implant interval.
In the group 1 (1–3 years) and group 2 (4–6
Discussion
Despite a recommendation for simultaneous implants, several families may decide to wait for the second implant [18]. The most common reason was a lack of acceptance by the child's family that their child was deaf. Other reasons included concerns over postoperative appearance, a child's reluctance to give up the hearing aid despite a lack of residual hearing, and wanting to wait for future technologies. Potential family concerns are that the implant will not help their child, or are based on a
Conclusion
Several authors have postulated a sensitive period for auditory development, which may have implications for outcomes with cochlear implants However, as demonstrated in the current study, many patients derive significant benefit in speech understanding with a second implant and with bilateral implants, despite a prolonged duration of deafness in the sequentially implanted ear and a significant inter-implant interval.
Source of financial support or funding
None.
Conflict of interest
The authors declare no conflict of interest.
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Cited by (21)
A longitudinal study of cortical auditory maturation and implications of the short inter-implant delay in children with bilateral sequential cochlear implants
2023, International Journal of Pediatric OtorhinolaryngologyEffects of bilateral cochlear implants in children: Timing of second surgery and the significance of wearing bilateral cochlear implants in Japan
2020, Auris Nasus LarynxCitation Excerpt :To evaluate the impact with bilateral CI, speech perception in noise and left–right discrimination was examined. A similar study by Bianchin et al. reported that speech intelligibility in noise improved in all three groups classified by a short (1–3years), medium (4–6years), and long (7–12years) range interval between both implantations [19]. However, in this study, superior speech perception with bilateral CIs in noise was not observed even in the group A patients who had both cochlear implantations before 3.5 years old, although the 2nd CI had similar speech perception ability with 1st CI in this group.
Cochlear Implant
2020, Otolaryngologic Clinics of North AmericaCitation Excerpt :In children, this decision is often not as relevant, although the decision to perform bilateral CI in a single or sequential procedures has become relevant in this population. Certainly, evidence supports benefit from bilateral CI in children; however, it remains unclear if a single procedure offers overall benefit compared with sequential procedures.19,20 Ultimately, as the criteria for CI evolve, the decision-making process becomes more complex, which requires comprehensive discussions among patients, family, physicians, and audiologists.
The relationship of inter-implant time and hearing outcomes for bilateral cochlear implants
2020, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :The question then arises of how long a patient can feasibly wait between implants before he or she runs the risk of compromising his or her hearing. For pediatric patients, many studies back up the claim that simultaneous bilateral implants or a shorter inter-implant interval leads to better long-term hearing outcomes [2–6]. This is usually seen as a consequence of capturing the critical period of language and hearing development that occurs during this age and ensuring that both the neural auditory tracts and the connections between them receive proper stimulation early in life [4].
Sequential bilateral cochlear implant: results in children and adolescents
2019, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :On the other hand, the long interval between surgeries and the age at which the 2nd CI is performed can directly impact the results of auditory perception of speech with the bilateral CI, in addition to the fact that a late 2nd CI might not favor adequate neural connections, generating inferior results for the second implanted ear and a decrease in motivation regarding the use of another device, which did not attain the performance of the 1st CI. 12,13,19 However, it remains unclear whether there is a critical age and/or period for the indication of the second CI in this group of children with prelingual hearing loss who have used unilateral CI for many years.15,20,21 The use of hearing aid prior to the 2nd CI positively influenced the speech perception results with the use of the 2nd CI, since better results were found both in silence and in noise for the group that used the hearing aid (Table 1).