We all know that the younger children are the easier it is to increase brain development. We also have known that the earlier children receive cochlear implants (or hearing aids) the better their language.
Well, it will be no surprise that we know have data that confirms this. A study from the Children’s Hospital of Chicago has confirmed that infants who receive cochlear implants before 12 months of age may be more likely to use spoken language as their sole means of communication.
The study published in Otology and Neurotology studied 219 children some of whom received implants before 12 months compared to children implanted between 37 and 39 months. Children who were implanted earlier understood spoken language earlier – 3.3 years vs 4.3 years and were more likely to use spoken language as their means of communication (88.2% vs 48.8%).
This confirms what those clinicians who work with children with severe and profound hearing loss already know. Earlier is better. Unfortunately, early implantation is not public policy now. Since it is not, evaluating children early for CI candidacy does not happen early enough.
What has to happen?
- Early identification – it is not enough to do newborn hearing screening. We need to follow up. A system needs to be developed that will arrange for quick follow-up. We need to have a way to have pediatric audiology appoints available so that babies can be seen quickly.
- If hearing loss is identified, we have to try and get hearing aids on babies instantly – yes I said instantly
- Parents (and pediatricians) need to be helped to understand that hearing loss in babies is a neurologic emergency. They need to understand that children need to be wearing the hearing aids at least 10 hours/day
- Babies need to be enrolled in therapy quickly with clinicians who are able to provide auditory based therapy to help parents and other caregivers understand how to build auditory and language skills.
- Audiologists and therapists together need to follow how babies are learning to listen. If they are not, they need to move quickly to refer babies to a CI team for evaluation.
- CI programs need to move quickly to move families through the evaluation process so that babies can be implanted early.
What interferes with what needs to happen?
- Screening programs may not help families understand that hearing loss is a neurological emergency so families may not move quickly.
- Pediatric audiologists should be able to get babies in quickly – leave appointments empty to get babies in quickly (yes you can do it – we did it in programs I directed.)
- Audiologists who are fitting hearing aids on babies but are not in programs which are doing CI management needs to really keep up with what is happening with CI’s and need to know when to refer babies for CI evaluation. Remember – CI evaluation does not guarantee a child will be a CI candidate. But early CI evaluation will catch babies who need to be implanted and help get babies implanted early.
- Audiologists who fit hearing aids need to ask both therapists and parents what exactly the baby is hearing and what she is not hearing to help know when to refer. (Ask parents and therapists to keep track of how a child hears the Ling 6 sounds in each ear and at different distances. If the baby is not able to hear all of the Ling 6 sounds at at least 6 feet with a normal voice, refer.
- CI programs need to have a fast track system for babies. Babies who have severe to profound hearing loss, and who are not hearing well enough, need to be implanted quickly.
What do we know?
This problem is solvable. Everyone who works with children with hearing loss needs to be aggressive and help move children with hearing loss move through the system quickly. We can do it!!! The babies need us to do it!!!
**featured image courtesy Wikimedia Commons