Introduction: Parents of deaf and hard of hearing (DHH) children often ask otolaryngologists (ENTs) for prognostic information about spoken language outcomes after cochlear implant (CI) surgery. There is a general consensus that early amplification in DHH children helps mitigate subsequent language delays. However, the expected outcomes are rarely predictable. ENTs should therefore be informed about empirically-documented language outcomes in order to provide the best guidance.
Methods: We reviewed all 30 publications (2008-2018) from the Childhood Development After Cochlear Implantation (CDaCI) study: a prospective, multi-site, longitudinal study of 188 pediatric CI recipients. We extracted all reported standardized language assessment data and visualized them for ease of interpretation. We included all subgroup means, defined according to the criteria used in each publication.
Results: 15 of 30 papers reported language scores. CI recipients’ language scores were near floor throughout ages 0-5y. At school entry, the mean score of the best-performing subgroup remained a full standard deviation below age expectation and did not reach age-appropriate levels until the late elementary years. Mean scores of all other subgroups remained more than 1 standard deviation below age expectation at all time-points tested.
Conclusion: Despite much progress, spoken language outcomes for participants in the CDaCI study did not reach age expectation. When counseling families on cochlear implantation, one should be careful to not provide an overly simplified prognosis. While surgical outcomes remain excellent, families must understand that exclusive reliance on auditory access via cochlear implants allows the possibility that their child will not develop age-appropriate mastery of any language by school entry, even with timely and appropriate intervention and habilitation. Understanding this risk is a crucial part of equipping families to make informed decisions about their child’s care.