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Cochlear implants: Early surgery is best for children who can't hear, speak -Experts.

For children that are born with hearing loss, impaired speech, a cochlear implant could be the solution but how soon should the surgery be done to have maximum efficacy? This report with input from medical experts and researchers answers this question and more.

What are cochlear implants?

Often referred to as 'bionic ears,' cochlear implants are much different than hearing aids, which only amplify sounds, experts say. By contrast, cochlear implants bypass damaged parts of the ear and stimulate the auditory nerve. The implant generates signals that are sent to the brain via the auditory nerve. The brain then recognises these signals as sound. These small electronic devices consist of an external component that sits behind the ear, and a second part that is surgically placed under the skin.

How much do cochlear implants cost?

The costs of cochlear implants vary widely depending on a number of factors, including the duration and extent of a patient's hearing loss prior to surgery. The average cost for the entire procedure, including the post-operative aural rehabilitation process, exceeds $40,000 in most cases.

When does a child require cochlear implants?

According to Dr Odebunmi Ogundoyin of Skyline Specialist Clinic Ibadan, children with sensorineural hearing loss, a condition in which there is damage to the inner ear, usually require cochlear implants. These are children with hearing pathology and speech impairment due to a damaged cochlear. The cochlear is a part of the inner ear and if it gets damaged either during child birth or as a result of infections, then there is a problem.

Although sometimes, hearing loss in children could be congenital, meaning the child is born that way or due to the trauma of child birth. Sometimes, women are advised to have their babies through Caesarean Section (CS) when labour becomes too rigorous but some women refuse. So, the trauma of such birth could affect the child. Also, there is the issue of hearing loss secondary to infections. When there is a rubella infection, the virus could affect multiple organs in the child. That is why women are advised to do regular antenatal checkups but most of them don't. This leads to birthing children with multiple abnormalities.

How soon should a child who requires cochlear implant get it

Ogundoyin explained thus: 'The truth is that the surgery for cochlear implant is better done when the child is still young because if the child attains a certain age, it may not be as effective. The child stands a better chance from about two to maybe five or six years or later but the earlier is the better, when it comes to receiving cochlear implants for children hearing loss.'

Can speech be achieved by children who receive cochlear implants?

Yes, since the children would be able to hear after receiving cochlear implants, speaking is very possible. They would be able to speak after the surgery. However, such child would require regular follow ups and speech therapy to help the language development.

The sooner children with hearing loss receive cochlear implants, the better, experts worldwide equally affirm. According to a multicenter study led by scientists at Johns Hopkins Medical Institutions in the United States of America, receiving a cochlear implant before 18 months of age dramatically improves a deaf child's ability to hear, understand and eventually, speak.

In the study, 'Spoken Language Development in Children Following Cochlear Implantation' which was published in the April 21 issue of the Journal of the American Medical Association (JAMA), researchers followed 188 children, ages 6 months to 5 years, with profound hearing loss for three years after receiving cochlear implants at six U.S. hospitals. They tracked the children's newly emerging ability to recognize speech after the implant, and compared their levels of language development to those of 97 same-age children with normal hearing and discovered the following.

Age as a predictor of improvement

While speech and language skills improved in all children regardless of age after they received a cochlear implant, age emerged as a powerful predictor in just how much improvement was seen. The finding points to a critical window for diagnosis and treatment, one that does not stay open for very long. Therefore, the researchers say, delaying implantation deprives children of essential exposure to sounds and speech during the formative phases of development when the brain starts to interpret the meaning of sounds and speech.

'We identified a clear pattern where implantation before 18 months of age conferred a much greater benefit than later implantation, allowing children to catch up fast, sometimes to nearly normal levels,' said lead investigator John Niparko, director of Otolaryngology, Head and Neck Surgery at Johns Hopkins. 'Delaying intervention until a child loses every last bit of hearing deprives the brain of much-needed sound and speech stimulation that is needed to develop language.'

Each year of delay, the investigators say, can put a child a year behind in language development. Therefore all young infants with suspected hearing loss, and those with family history, should be monitored vigilantly and referred for treatment immediately, experts say.

Children who received a cochlear implant before age 18 months nearly caught up with their normal-hearing counterparts over the subsequent three years. Children who received implants after age 3 had language gaps that corresponded directly to the length of delay before receiving the implant.

The study also showed that children implanted before age 18 months managed to reach speech and language developmental milestones much faster than those who received their implants later. When researchers looked at verbal expression milestones, a pattern of delay emerged. The gap between chronologic age and language age grew wider the later a child underwent implantation.

Another important factor in language development was how soon and how much the parents interacted with a child, the study found.

'The impact of early cochlear implantation was greatly augmented in children whose caregivers use language to engage them,' Niparko said. 'And we cannot overestimate the importance of caregiver communication with babies at a very early age, whether they have some degree of hearing loss or normal hearing.'
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Publication:Nigerian Tribune (Oyo State, Nigeria)
Date:Jan 13, 2018
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