Newborn hearing screening has ensured that deaf infants are identified soon after birth so that habilitation can begin as early as possible. Cochlear implantation is a key component of early intervention for some children, but it is often not performed until after they are 12 months old. Our Editors’ Choice paper reviews a study which identifies many of the barriers to earlier implantation and suggests ways to mitigate these issues. Many thanks as always to our reviewers for all their hard work and contributions.
Nazia Munir and Hannah Cooper
The brain has a critical period where auditory input is required to prevent auditory deprivation in prelingually deafened children. Therefore, the earlier cochlear implantation can take place in congenitally deafened children the better the language outcomes are likely to be. Studies have shown that those implanted with cochlear implants before the age of 12 months have better outcomes than those implanted between 12 and 24 months. The Emmeline Centre in Cambridge investigated retrospectively over a period of three years the potential barriers to implanting before the age of 12 months that existed in their centre. The areas audited included: the child’s age at each stage in the assessment pathway, from referral, to surgery and then switch-on; the behavioural, imaging and ABR data; whether a hearing aid trial was necessary and management of otitis media with effusion (OME). Age at referral was important, with those referred before six months of age being implanted younger. Those who had OME were also implanted later than those children with normal tympanometry: on average nearly five months later. Overall, only 5% of children were implanted before 12 months of age, but 79% were implanted before they were 18 months old. This study highlighted the challenges that UK centres face when trying to implant children before 12 months of age. Procedural changes such as encouraging early referrals from local centres, starting behavioural testing earlier, no routine repeat ABR, no watchful wait for OME to resolve, and earlier switch-on has helped reduced the age at implantation in this centre.