Cochlear implants benefit children with hearing loss and developmental delays, says study

A recent study by Keck Medicine of the University of Southern California (USC) examined whether there was a greater efficacy when using cochlear implants vs hearing aids in children with severe developmental delays.¹

Typically, infants experiencing hearing loss are first treated using hearing aids. If hearing aids fail to help the patients develop early language and speech skills, at 12 months or older they become eligible for cochlear implants. Cochlear implants are small, electronic devices surgically placement under the skin to stimulate nerve ending in the ear, providing a sense of sound.²

However, for children with severe developmental delays—low cognitive skills, low adaptive or learned behavior—some insurance companies continue to deny coverage of cochlear implants due to the belief that they will not help these patients learn to communicate.

Now, a new study by Oghalai et al has demonstrated improved cognitive, adaptive behavior, language, and auditory in deaf children with early developmental impairment when using cochlear implants.¹

John Oghalai, MD, otolaryngologist with Keck Medicine, chair of the USC Caruso Department of Otolaryngology—head and neck surgery, and lead author of the study, sat down with Contemporary Pediatrics® to discuss the study.

Identifying young children with deafness from both Texas and California, Oghalai explained he used the states differing insurance coverage capabilities to compare outcomes.

“We took advantage of the fact that in California, the California Medicaid or CCS [California Children Services] wouldn’t cover cochlear implantation for children with cognitive delays,” he said. “So, these kids didn’t really have that option of getting cochlear implants. Whereas in Texas, [the states] similar type of [Medicaid] insurance would actually cover cochlear implants. So, we could compare the 2 sites, both at Stanford Children’s and Texas Children’s and compare outcomes.”

The children chosen for the study were followed longitudinally for an average of 2 years and split into 3 cohorts. Cohort 1 (n = 138) underwent cochlear implantation and were reported to have normal cognition and adaptive behavior, cohorts 2 (n = 37) and 3 (n = 29) were comprised of children with low cognitive adaptive behavior. Patients in cohort 2 underwent cochlear implantation while those in cohort 3 were treated using hearing aids. Cognition, adaptive behavior, language, and auditory skills assessed included the ability to notice, compare, and distinguish sounds in words.

“We did special types of studies to look for outcomes that might be considered valuable and meaningful in this population,” Oghalai said. “Yes, we looked at speech, we looked at language development, but these were kids where maybe that wasn’t going to be a top priority or expected outcome, so we looked at cognitive status, ability to interact with people in their environment, and parental stress, which is a measure of quality of life.”

Before being assigned a cohort, all participants, approximately 200, began the study wearing hearing aids. Throughout the study, investigators compared the progress of children who either continued using hearing aids, or those who received cochlear implants.

At the time of final assessment, children with cochlear implants—including those with learning delays—showed almost 25% improvement in tracked skills compared to participants using hearing aids.

While over the course of the study more insurance providers began covering cochlear implants for deaf children regardless of developmental impairments, Oghalai noted that some insurance providers, pediatricians, and cochlear implant teams are still unwilling or slow to provide this procedure to children with developmental delays. He noted that he hopes the results of this study will help expand care to this population.

“Anybody who works in the clinics recognizes how hard it is to get anything covered, even regular medical services that everybody should get access to. Insurance companies look for ways to stall, delay, and deny.” He said, adding that this study and others have shown improvements in “quality of life, ability to adapt in an environment, and interact with people, and even improve speech and language in these children where we have to have appropriate expectations.”

References:

1. Oghalai JS, Bortfeld H, Feldman HM, et al. Cochlear implants for deaf children with early developmental impairment. American Academy of Pediatrics. Doi: 10.1542/peds.2021-055459
2. Deaf children with learning delays benefit from cochlear implants more than hearing aids. Keck Medicine of USC. Published May 24, 2022. Accessed May 25, 2022. https://news.keckmedicine.org/deaf-children-with-learning-delays-benefit-from-cochlear-implants-more-than-hearing-aids/