What age can a child have a cochlear implant?

01 Cochlear implantation at an extremely young age comes with pre

“The earlier the implantation, the better the results”, for children implanted with a cochlear implant at an extremely young age, there are preconditions.
At present, the youngest patient implanted with a cochlear implant abroad is 4 and a half months old, and in China, it is currently 5 and a half old.

But I must repeat this important point three times, these extremely young implantees are not because “the earlier the implantation, the better the results”, extremely young implantees are not because “the earlier the implantation, the better the results”, these extremely young implantees are not because “the earlier the implantation, the the results”.

Rather, it is because of some special conditions (such as meningitis), which may cause cochlear ossification, and it too difficult to implant at a later age.

About 10 years ago, the youngest child implanted with a cochlear implant in China was 9 and a half old, and it was generally believed at that time that children over 1 year old could be implanted. That child was implanted at 9 and a half months old because the possibility of cochlear ossification.

By the way: “Cochlear ossification” used to be a contraindication, but in recent years doctors have figured out how to implant, but this type of surgery does indeed belong to the type of implantation that requires extremely high requirements, and any doctor who is slightly inexperienced not do it.

02 What are the difficulties of cochlear implantation at a very young age?

1. Surgeons who can perform cochlear implant surgery are not easy to train.

In practice some practitioners and parents will use “a doctor has performed too many cochlear implant surgeries on young children” as a reference for technical level, which is not wrong, but should be over-glorified. The premise of any surgery is medical safety, and I have met several top cochlear implant surgeons in China, none of whom would particularly emphasize performed cochlear implant surgery on a child as young as six months old (although they probably have).

Setting aside complex cases, routine cochlear implant surgery is not a very difficult surgery that does not require craniotomy. Any doctor with extensive experience in middle ear surgery, especially those with a deep understanding of the temporal bone (one of most complex bones in the human body), can gradually perform cochlear implant surgery.

It should be said that cochlear surgery is a “clever” surgery not a too difficult one. I remember a female doctor saying that she liked being an otolaryngologist because many otolaryngological surgeries are performed “under the microscope and she can “sit down” without being too tired. Although this statement is somewhat self-deprecating, it is true that “cleverness” and “experience are more important than “physical strength.”

We must know one fact, that is: the growth of otolaryngologists basically can be said to be the slow among all departments. This is because there are too few otolaryngological cases in primary hospitals, many doctors have not seen enough cases, and the domestic shared case database data only been organized in a few top hospitals in recent years, and cochlear implant surgery videos and live videos have also become available, giving some visiting and standardized training doctors the opportunity see them. Even in a province, there are only a few hospitals specializing in otolaryngology. After all, as we all know, otolaryngology is a particularly popular department. Most hospitals classify it as “Otorhinolaryngology,” and only a few top hospitals in Beijing and Shanghai have an “Otolaryology Head and Neck Surgery” department (where otolaryngology exists as a sub-specialty).

To measure the level of a cochlear implant surgeon patients and families generally consider two main data: the number of implants and the experience with complex surgeries. It is generally believed that a doctor who has performed more than 50 colear implants is very good, and a doctor who has performed more than 300 is already a big shot, and the standard for a top cochlear implant surgeon is500. Once you get past 500, you’ve basically dealt with everything. As for the experience with complex surgeries (including revision surgery experience), I’t go into detail here. It mainly involves preventing some problems during surgery, and to go into more detail would be at a professional rather than popular science level, and I dare speak blindly.

2. Teamwork, especially anesthesia

Cochlear implantation in young children mainly involves anesthesia, the of the doctor, the size of the incision, preoperative preparation, postoperative bandaging, and care, etc.

The most important thing here is anesthesia:hesia for young children is more difficult to master, and it requires a very professional anesthesiologist to cooperate (bilateral implant surgery takes longer, so it is even more for the overall team to coordinate well). A decade ago, cochlear implant surgery was still quite dangerous, and it is said that complications from anesthesia were not uncommon. some hospitals do not have a dedicated “pediatric anesthesiologist.”

And now it is basically teamwork. From this perspective, you must choose a doctor and with experience when it comes to cochlear implants. “Flying knife” is also possible, but few top cochlear implant doctors are willing to go to inexperienced hospitals.
Proficiency of the doctor: This mainly has to do with the amount of bleeding during surgery, the duration of the implant surgery, the timing and technique of “inserting electrode,” and the handling of unexpected situations. Because it is too professional, I will not reply to this in a science popularization article, and parents do not need to know much about it.

But here I must emphasize one thing: any doctor who boasts that he can implant in half an hour should not be chosen, you don’t know kind of doctor is blowing such a trumpet.

Dr. Cao Kelili, the first expert in cochlear implantation in China at Peking Union Medical College, once said: “The only difference between my first surgery and my 3000th surgery is the experience and skill of implantation, and the implantation process must be skipped.”

Fast surgery with less bleeding and minimally invasive, but the rigor of the process is the most important. Therefore, these top doctors do not emphasize too how fast they can do it.

On the contrary, I have seen a doctor with an unknown confidence do a surgery. The surgery itself was fine, but the location of incision and the location of the bone grinding were very strange. There is actually a “ruler” in the cochlear packaging. Before making the incision, you have put the “ruler” on the patient’s head and “draw a line” to choose the most appropriate incision position. Some with super experience can skip this step. at that time, that “not very experienced” doctor was too casual, resulting in the location of the bone grinding and the incision position being too close, and the patient could wear the processor behind the ear after surgery (of course, this is just my analysis, it could also be that there were other situations during the surgery that had to choose this)

03 Why is “the earlier the implantation, the better the effect”?

This is related two issues. One is the development of the auditory center of the brain; the other is the golden period of language development (as well as the development of the language center the brain).

We know that the functional zoning and development of the brain are basically completed before the age of 3. For children with normal hearing, they basically start make unconscious sounds around 8 months old, and about 70% of their language ability will be formed before the age of 3, and the later development will be improved with the improvement of knowledge and cognition. And the response to sound will be rapidly established after birth, and the “auditory memory” of many sounds will be established before age of 1.

Therefore, there is a “golden period” of hearing and language development. Some literature believes it is before the age of 3, some believes it is before the age of 6, and some literature believes it is before the age of 12. And from the perspective of linguistics, it supports the idea children have the ability to communicate at the age of 3. So we will temporarily count as 3 years old. From my own subjective feeling, it is true that children who deaf before the age of 3 and are implanted with cochlear implants after the age of 3 need a lot of language rehabilitation and the family pressure is also very high This is also why we say “cochlear implantation for children aged 0-6 is a life-saving surgery”. It is not that the surgery is life-, but that there is a “golden period” of time.

Therefore, the establishment of auditory memory should not be later than 2-3 years old.
For children with congenital profound hearing loss, who have no original hearing and residual hearing, it is necessary to establish auditory memory as soon as possible, and there is a saying that the earlier the implantation, the better.

In addition, the lower limit of the FDA and CFDA for cochlear implantation guidance age is year old, so we can have a preliminary conclusion that “1-3 years old is the golden period of cochlear implantation”.

Then is it better to before the age of 1?

In practice, for children with congenital profound hearing loss, most doctors’ advice is “8 months to 1.5 years old. The lower limit is 6 months old, mainly because most children can be diagnosed only at the age of 6-8 months.

And there is a small sample conclusion that the effect is best at 1.5 years old, but this small sample data is more than ten years ago, when there were very few children implanted under the of 1. In recent years, due to the popularization of newborn hearing screening, children are being discovered to have hearing loss at an increasingly younger age. So we can further that “8 months to 1.5 years old” is indeed a relatively recognized period with a very good effect.

Then will there be a “delay” argument during period of 1.5 to 3 years old for implantation?

This is also a common argument. Objectively speaking, language is formed at the age of -3, and it should indeed have auditory stimulation before the age of 2. But we also can’t ignore a fact, that is, children’s language itself has early and late, and the same is true for hearing children, we can’t attribute all the “delay” to hearing. In my personal opinion, it is not a to be implanted around the age of 2, but just need more assessment and more effort should be put into rehabilitation

The formation of language is not only related to hearing but also to the child’s cognition. If parents really implant a little later for whatever reason, should not be blamed excessively. In reality, there are many children who perform well after implantation at an older age. It is absolutely not right to use this information asymmetry and parents’ sense of guilt to put excessive demands on them. Parents’ psychology is actually very fragile. Since good results can also be achieved with follow-up rehabilitation, there is no to dwell on the word “delay”.

04 Clear the window of cochlear implantation

In the above text, we have made it clear that for bilateral profound loss, cochlear implantation should be considered within the time window of “8 months – 1.5 years old”.

For children with residual hearing or who benefit from hearing aids, as well as adults who become deaf after acquiring language ability, there is no strict requirement for such a window period. However, if it is found that the childs hearing aid effectiveness lags far behind that of peers, and the child’s language development has shown obvious abnormalities compared to the general population, cochlear implantation should performed as soon as possible to avoid delaying the child’s hearing and language learning.

So is it necessary to be 8 months old? Some parents are in a. Actually, there is no need to rush. Whether it is 8 months or 1 year old, it doesn’t matter. There is no evidence that 8 months better than 1 year old. Moreover, children’s cognitive levels are different, and individual conditions are different. There is no such thing as “delay”. Sharpening knife does not delay cutting firewood. (For bilateral profound hearing loss, if implantation is performed after the age of 3, it is indeed somewhat delayed.)

cochlear implantation, it is also okay if language development is slow. Just follow a planned auditory and language rehabilitation program. Children with normal hearing also have early and late. Do not attribute all problems to hearing.

We have seen a hearing aid center that has been deceiving the parents of a child with severe hearing loss (who should have implanted with a cochlear implant according to the standard) to replace the hearing aid once a year, but the child’s language development is very poor. This has to said to be a typical case of parents being stupid and businesses being evil, which is not fair to the child.

05 Language is more important than hearing

It is important to treat hearing aids and cochlear implants objectively. Strictly, they are not for “returning to the world of sound”, but only for “returning to the world of language”. The design life of a cochlear is 70 years, but it may not last that long, or it may be removed due to an accident and become deaf. However, the real value of a coch implant is “to provide users with a time period to return to the world of language”. No one can guarantee how long this period will last.

There are some parents I really find ignorant. They hope to wait for future treatment, so they do not provide any intervention or language rehabilitation for their children. In fact, even if there is a treatment in the future, the child has already missed the best period for auditory development and language development.
Therefore, whether it is the user or the parent, it is important to this sentence “language is more important than hearing”.

In addition, if there is a hearing loss, it is worth understanding if they are unwilling to have a coch implant, whether it is due to financial ability or ideological issues. However, it is important to remember to strengthen language training. Wearing a hearing aid (which may not be) can only stimulate the auditory nerve, not to let the auditory nerve atrophy. In the future, whether there are other treatment methods or decide to have a coch implant, there is a possibility of implantation. Otherwise, if the brain has no auditory memory and the auditory nerve has also atrophied, the implantation may be or the effect is very poor.