Objectives: Although deaf children with cochlear implants (CIs) are able to develop good language skills, the large variability in outcomes remains a significant concern. The first aim of this study was to evaluate language skills in children with CIs to establish benchmarks. The second aim was to make an estimation of the optimal age at implantation to provide maximal opportunities for the child to achieve good language skills afterward. The third aim was to gain more insight into the causes of variability to set recommendations for optimizing the rehabilitation process of prelingually deaf children with CIs. Design: Receptive and expressive language development of 288 children who received CIs by age five was analyzed in a retrospective multicenter study. Outcome measures were language quotients (LQs) on the Reynell Developmental Language Scales and Schlichting Expressive Language Test at 1, 2, and 3 years after implantation. Independent predictive variables were nine child-related, environmental, and auditory factors. A series of multiple regression analyses determined the amount of variance in expressive and receptive language outcomes attributable to each predictor when controlling for the other variables. Results: Simple linear regressions with age at first fitting and independent samples t tests demonstrated that children implanted before the age of two performed significantly better on all tests than children who were implanted at an older age. The mean LQ was 0.78 with an SD of 0.18. A child with an LQ lower than 0.60 (= 0.78-0.18) within 3 years after implantation was labeled as a weak performer compared with other deaf children implanted before the age of two. Contralateral stimulation with a second CI or a hearing aid and the absence of additional disabilities were related to better language outcomes. The effect of environmental factors, comprising multilingualism, parental involvement, and communication mode increased over time. Three years after implantation, the total multiple regression model accounted for 52% of the variance in receptive language scores and 58% of the variance in expressive language scores. Conclusions: On the basis of language test scores of this large group of children, an LQ of 0.60 or lower was considered a risk criterion for problematic language development compared with other deaf children using CIs. Children attaining LQs below 0.60 should be monitored more closely and perhaps their rehabilitation programs should be reconsidered. Improved language outcomes were related to implantation under the age of two, contralateral stimulation, monolingualism, sufficient involvement of the parents, and oral communication by the parents. The presence of an additional learning disability had a negative influence on language development. Understanding these causes of variation can help clinicians and parents to create the best possible circumstances for children with CIs to acquire language.

Predictors of spoken language development following pediatric cochlear implantation.

https://www.uio.no/studier/emner/uv/isp/SPED4100/h13/dokumenter/language-development-in-children-after-receiving-bilateral-cochlear-implants-between-5-and-18-months.pdf

Language development in children after receiving bilateral cochlear implants between 5 and 18 months

Purpose The authors studied the effect of the cochlear implant (CI) on language comprehension and production in deaf children who had received a CI in the 2nd year of life. Method The authors evalu...

Cochlear Implant in the Second Year of Life: Lexical and Grammatical Outcomes

Objective: To examine spoken language outcomes in children undergoing bilateral cochlear implantation compared with matched peers undergoing unilateral implantation.
Design: Case-control, frequency-matched, retrospective cross-sectional multicenter study.
Setting: Two Belgian and 3 Dutch cochlear implantation centers.
Participants: Twenty-five children with 1 cochlear implant matched with 25 children with 2 cochlear implants selected from a retrospective sample of 288 children who underwent cochlear implantation before 5 years of age.
Intervention: Cochlear implantation.
Main Outcome Measures: Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales and Schlichting Expressive Language Test).
Results: On the receptive language tests (mean difference [95% CI], 9.4 [0.3-18.6]) and expressive language tests (15.7 [5.9-25.4] and 9.7 [1.5-17.9]), children undergoing bilateral implantation performed significantly better than those undergoing unilateral implantation. Because the 2 groups were matched with great care on 10 auditory, child, and environmental factors, the difference in performance can be mainly attributed to the bilateral implantation. A shorter interval between both implantations was related to higher standard scores. Children undergoing 2 simultaneous cochlear implantations performed
better on the expressive Word Development Test than did children undergoing 2 sequential cochlear implantations.
Conclusions: The use of bilateral cochlear implants is associated with better spoken language learning. The interval between the first and second implantation correlates negatively with language scores. On expressive language development, we find an advantage for simultaneous compared with sequential implantation.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/1107678/poa110021_28_34.pdf

Effect of pediatric bilateral cochlear implantation on language development

https://www.oto.theclinics.com/article/S0030-6665(11)00150-2/pdf

Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria.

Bilateral versus unilateral cochlear implantation in young children

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Bilateral versus unilateral cochlear implantation in young children