Influence of implantation age on school-age language performance in pediatric cochlear implant users

Abstract

Objective: This study examined specific spoken language abilities of 160 children with severe-to-profound sensorineural hearing loss followed prospectively 4, 5, or 6 years after cochlear implantation. Study sample: Ninety-eight children received implants before 2.5 years, and 62 children received implants between 2.5 and 5 years of age. Design: Language was assessed using four subtests of the Comprehensive Assessment of Spoken Language (CASL). Standard scores were evaluated by contrasting age of implantation and follow-up test time. Results: Children implanted under 2.5 years of age achieved higher standard scores than children with older ages of implantation for expressive vocabulary, expressive syntax, and pragmatic judgments. However, in both groups, some children performed more than two standard deviations below the standardization group mean, while some scored at or well above the mean. Conclusions: Younger ages of implantation are associated with higher levels of performance, while later ages of implantation are associated with higher probabilities of continued language delays, particularly within subdomains of grammar and pragmatics. Longitudinal data from this cohort study demonstrate that after 6 years of implant experience, there is large variability in language outcomes associated with modifiers of rates of language learning that differ as children with implants age.

Key Words::

• Cochlear implants
• language
• pediatrics
• syntax
• vocabulary
• pragmatics
• comprehension

Acknowledgements

The authors wish to thank all the participants and their families. Portions of this work were presented at the 13th Symposium on Cochlear Implants in Children, Chicago, USA, July 14–16, 2011.

I presented the contrasts between the unadjusted and adjusted results listed in Table 3 as an invited talk on confounding adjustment in CI2012 in Baltimore (Niparko’s invite). Should we list that here too?

Declaration of interest: The authors report no declarations of interest. This work was sponsored, in part, by the National Institutes of Health, NIDCD R01DC04797 (J.K. Niparko, Principal Investigator).

CDaCI Investigative Team Members

1. House Research Institute, Los Angeles: Laurie S. Eisenberg, PhD, CCC-A (PI); Karen Johnson, PhD, CCC-A (coordinator); William Luxford, MD (surgeon); Leslie Visser-Dumont, MA, CCC-A (data collection); Amy Martinez, MA, CCC-A (data collection); Dianne Hammes Ganguly, MA (data collection); Jennifer Still, MHS (data collection); and Carren J. Stika, PhD (data collection).

2. Johns Hopkins University, Listening Center, Baltimore: John K. Niparko, MD (PI); Steve Bowditch, MS, CCC-A (data collection); Jill Chinnici, MA, CCC-A (data collection); James Clark, MD (data assembly); Howard Francis, MD (surgeon); Rick Ostrander, EdD (data collection); Dawn Marsiglia, MA, CCC-A/SLP (data collection); and Jennifer Yeagle, MEd, CCC-A (data collection).

3. Johns Hopkins University, The River School, Washington, DC: Nancy Mellon, MS (administration); Meredith Ouellette, MS (coordinator); Meredith Dougherty, MS (data collection); Patricia Gates-Ulanet, PhD (data collection); and Julie Verhoff, AuD, CCC-A (data collection).

4. University of Miami, Miami: Annelle Hodges, PhD, CCC-A (PI); Thomas Balkany, MD (surgeon); Alina Lopez, MA, CCC-SLP/A (coordinator); Leslie Goodwin, MSN, CCRC (data collection).

5. University of Michigan, Ann Arbor: Teresa Zwolan, PhD, CCC-A (PI); Caroline Arnedt, MA, CCC-A (clinic coordinator); Hussam El-Kashlam, MD (surgeon); Kelly Starr, MA, CCC-SLP (data collection); and Ellen Thomas, MA, CCC-SLP, Cert AVT (data collection).

6. University of North Carolina, Carolina Children”s Communicative Disorders Program, Chapel Hill: Holly F.B. Teagle, AuD, CCC-A (PI); Craig A. Buchman, MD (surgeon); Carlton Zdanski, MD (surgeon); Hannah Eskridge, MSP (data collection); Harold C. Pillsbury, MD (surgeon); and Jennifer Woodard (coordinator).

7. University of Texas at Dallas, Dallas Cochlear Implant Program, Callier Advanced Hearing Research Center, Dallas: Emily A. Tobey, PhD, CCC-SLP (PI); Lana Britt, AuD, CCC-A (Co-coordinator); Janet Lane, MS, CCC-SLP (data collection); Peter Roland, MD (surgeon); Sujin Shin (data collection); Madhu Sundarrajan, MS, CCC-SLP (data collection); and Andrea Warner-Czyz PhD CCC-A (co-coordinator);

Resource centers

1. Data Coordinating Center, Johns Hopkins University, Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore: Nae-Yuh Wang, PhD (PI, biostatistician); Christine Carson (study manager, data analysis); Thelma Grace (data assembly); Nancy E. Fink, MPH (former PI); and Patricia Bayton (data assembly).

2. Psychometrics Center, University of Miami, Department of Psychology, Coral Gables: Alexandra Quittner, PhD (PI); Ivette Cruz, PhD (data analysis); Cara Kimberg (data assembly); Sandy Romero (data assembly); and Mary Beth Grimley (data assembly).

Study oversight committees

1. Executive committee: John K. Niparko, MD (chair); Laurie S. Eisenberg, PhD; Nancy E. Fink, MPH (former member); Alexandra L. Quittner, PhD; Donna Thal, PhD; Emily A. Tobey, PhD; Nae-Yuh Wang, PhD.

2. External advisors: Noel Cohen, MD; Julia Evans, PhD; Ann Geers, PhD; Karen Iler Kirk, PhD.