Sequential pediatric bilateral cochlear implantation: The effect of time interval between implants

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Abstract

Objective

To examine speech intelligibility in children subjected to sequential bilateral cochlear implants (CI) surgery and to assess the influence of the inter-stage interval duration.

Introduction

Binaural hearing recovery can have additional benefits, especially in speech and language development in patients with congenital profound sensorineural hearing loss; so recently there has been an increase in the number of children receiving bilateral CI.

Methods

Twenty-seven children who underwent sequential bilateral cochlear implant (SBCI) with a short (1–3 yrs), medium (4–6 yrs) and long (7–12 yrs) range interval between both implantations, respectively, were evaluated. All patients underwent periodic speech perception test in quiet and noise after second implant activation in three conditions: with the first or second implant alone and with both implants. Results were examined according to the inter-stage interval.

Results

Speech intelligibility in noise was significantly better under bilateral conditions than either ear alone, in all three groups. Small improvements were seen in quiet, especially in the third group (6–12 yrs).

Conclusion

Benefits of second implant in the early-implanted children and after a short inter-implant delay are more evident. However our study support that, even after a long period of deafness and despite a prolonged inter-stage interval, sequential bilateral cochlear implantation should be considered.

Level of Evidence: Level 4.

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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