Like any other surgery requiring anesthesia, cochlear implantation in the first few years of life carries potential risks, which makes it important to assess the potential benefits. This study introduces a new method to assess the effect of age at implantation on cochlear implant outcomes: developmental trajectory analysis (DTA). DTA compares curves representing change in an outcome measure over time (i.e. developmental trajectories) for two groups of children that differ along a potentially important independent variable (e.g. age at intervention). This method was used to compare language development and speech perception outcomes in children who received cochlear implants in the second, third or fourth year of life. Within this range of age at implantation, it was found that implantation before the age of 2 resulted in speech perception and language advantages that were significant both from a statistical and a practical point of view. Additionally, the present results are consistent with the existence of a ‘sensitive period’ for language development, a gradual decline in language acquisition skills as a function of age.

Bollard PM, Chute PM, Popp A, Parisier SC: Specific language growth in young children using the Clarion cochlear implant. Ann Otol Rhinol Laryngol Suppl 1999;177:119–123.
Bortfeld H, Whitehurst G: Sensitive periods to first language acquisition; in Bailey D, Bruer J, Lichtman J, Symons F (eds): Critical Thinking about Critical Periods: Perspectives from Biology, Psychology, and Education. Baltimore, Brookes Publishing, 2001, pp 173–192.
Dawson PW, Blamey PJ, Dettman SJ, Barker EJ, Clark GM: A clinical report on receptive vocabulary skills in cochlear implant users. Ear Hear 1995;16:287–294.
Edwards S, Fletcher P, Garman M, Hughes A, Letts C, Sinka I: The Reynell Developmental Language Scales III: The University of Reading Edition. Los Angeles, Western Psychological Services, 1997.
El-Hakim H, Abdolell M, Mount RJ, Papsin BC, Harrison RV: Influence of age at implantation and of residual hearing on speech outcome measures after cochlear implantation: Binary partitioning analysis. Ann Otol Rhinol Laryngol 2002;189(suppl):102–108.
El-Hakim H, Levasseur J, Papsin B, Panesar J, Mount RJ, Stevens D, Harrison RV: Vocabulary acquisition rate after pediatric cochlear implantation and the impact of age at implantation. Int J Pediatr Otorhinolaryngol 2001a;59:187–194.
El-Hakim H, Papsin B, Mount RJ, Levasseur J, Panesar J, Stevens D, Harrison RV: Assessment of vocabulary development in children after cochlear implantation. Arch Otolaryngol Head Neck Surg 2001b;127:1053–1059.
Fenson L, Dale PS, Reznick JS, Thal D, Bates E, Hartung JP, Pethick S, Reilly JS: MacArthur Communicative Development Inventories. San Diego, Singular Publishing Group Inc, 1993.
Fryauf-Bertschy H, Tyler RS, Kelsay DM, Gantz BJ: Performance over time of congenitally deaf and postlingually deafened children using a multichannel cochlear implant. J Speech Hear Res 1992;35:892–902.
Geers A, Brenner C: Speech perception results: Audition and lipreading enhancement. Volta Rev 1994;96:97–108.
Geers A, Brenner C: Background and educational characteristics of prelingually deaf children implanted by five years of age. Ear Hear 2003;24:2S–14S.
Hurford JR: The evolution of the critical period for language acquisition. Cognition 1991;40:159–201.
Johnson JE, Newport E: Critical period effects in second language learning: The influence of maturational state on the acquisition of English as a second language; in Johnson MJ (ed): Brain Development and Cognition. Oxford, Blackwell, 1993, pp 248–282.
Jusckzyk PW, Houston D: Speech perception during the first year; in Slater A (ed): Perceptual Development: Visual, Auditory and Speech Perception in Infancy. East Sussex, UK, Psychology Press, 1998.
Jusckzyk PW, Luce PA: Speech perception and spoken word recognition: Past and present. Ear Hear 2002;23:2–40.
Kass E, Kogan SJ, Manley C, Wacksman JA, Klykylo WM, Meza A, Schultz J, Wiener E: Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. Pediatrics 1996;97:590–594.
Keenan RL, Shapiro JH, Kane FR, Simpson PM: Bradycardia during anesthesia in infants: An epidemiologic study. Anesthesiology 1994;80:976–982.
Kirk KI, Diefendorf AO, Pisoni DB, Robbins AM: Assessing speech perception in children; in Mendel LL, Danhauer LJ (eds): Audiologic Evaluation and Management and Speech Perception Assessment. San Diego, Singular Publishing Group Inc, 1997.
Kirk KI, Miyamoto RT, Lento CL, Ying E, O’Neill T, Fears B: Effects of age at implantation in young children. Ann Otol Rhinol Laryngol 2002;189(suppl):69–73.
Kuhl PK, Williams KA, Lacerda F, Stevens KN, Lindblom B: Linguistic experience alters phonetic perception in infants by 6 months of age. Science 1992;255:606–608.
Miyamoto RT, Robbins AM, Osberger MJ, Todd SL, Riley AI, Kirk KI: Comparison of multichannel tactile aids and multichannel cochlear implants in children with profound hearing impairment. Am J Otol 1995;16:8–13.
Newport EL: Maturational constraints on language learning. Cogn Sci 1990;14:11–28.
Osberger MJ, Miyamoto RT, Zimmerman-Phillips S, Kemink JL, Stroer BS, Firszt JB, Novak MA: Independent evaluation of the speech perception abilities of children with the Nucleus 22-channel cochlear implant system. Ear Hear 1991;12(suppl):66S–80S.
Osberger MJ, Zimmerman-Phillips S, Koch DB: Cochlear implant candidacy and performance trends in children. Ann Otol Rhinol Laryngol 2002;189(suppl):62–65.
Pickett JM, Stark RE: Cochlear implants and sensory aids for deaf children. Int J Pediatr Otorhinolaryngol 1987;13:323–344.
Richter B, Eissele S, Laszig R, Lohle E: Receptive and expressive language skills of 106 children with a minimum of 2 years’ experience in hearing with a cochlear implant. Int J Pediatr Otorhinolaryngol 2002;64:111–125.
Robbins AM: The Mr. Potato Head Task. Indianapolis, Indiana University School of Medicine, 1994.
Robbins AM, Kirk KI: Speech perception assessment and performance in pediatric cochlear implant users. Semin Hear 1996;17:353–369.
Ruben RJ: Unsolved issues around critical periods with emphasis on clinical application. Acta Otolaryngol 1986;429(suppl):61–64.
Spencer LJ, Barker BA, Tomblin JB: Exploring the language and literacy outcomes of pediatric cochlear implant users. Ear Hear 2003;24:236–247.
Spencer LJ, Tye-Murray N, Tomblin JB: The production of English inflectional morphology, speech production and listening performance in children with cochlear implants. Ear Hear 1998;19:310–318.
Staller SJ, Dowell RC, Beiter AL, Brimacombe JA: Perceptual abilities of children with the Nucleus 22-channel cochlear implant. Ear Hear 1991;12(suppl):34S–48S.
Stallings LM, Svirsky M, Gao S: Assessing the language abilities of pediatric cochlear implant users across a broad range of ages and performance abilities. Volta Rev 2000;102:215–235.
Strube MA: Statistical Analysis and Interpretation in a Study of Prelingually Deaf Children Implanted before Five Years of Age. Ear Hear 2003;24:15S–23S.
Svirsky MA: Language development in children with profound and prelingual hearing loss, without cochlear implants. Ann Otol Rhinol Laryngol 2000;185(suppl):99–100.
Svirsky MA, Chute PM, Green J, Bollard P, Miyamoto RT: Language development in prelingually deaf children who have used SPEAK or CIS stimulation strategies since initial stimulation. Volta Rev 2000a;102:199–213.
Svirsky MA, Robbins AM, Kirk KI, Pisoni DB, Miyamoto RT: Language development in profoundly deaf children with cochlear implants. Psychol Sci 2000b;11:153–158.
Svirsky MA, Sloan RB, Caldwell M, Miyamoto RT: Speech intelligibility of prelingually deaf children with multichannel cochlear implants. Ann Otol Rhinol Laryngol 2000c;185(suppl):123–125.
Svirsky MA, Stallings LM, Lento CL, Ying E, Leonard LB: Grammatical morphologic development in pediatric cochlear implant users may be affected by the perceptual prominence of the relevant markers. Ann Otol Rhinol Laryngol Suppl 2002;189:109–112.
Szagun G: The acquisition of grammatical and lexical structures in children with cochlear implants: A developmental psycholinguistic approach. Audiol Neurootol 2000;5:39–47.
Szagun G: Language acquisition in young German-speaking children with cochlear implants: Individual differences and implications for conceptions of a ‘sensitive phase’: Audiol Neurootol 2001;6:288–297.
Tomblin JB, Spencer LJ, Gantz BJ: Language and reading acquisition in children with and without cochlear implants. Adv Otorhinolaryngol 2000;57:300–304.
Vermeulen A, Hoekstra C, Brokx J, van den Broek P: Oral language acquisition in children assessed with the Reynell Developmental Language Scales. Int J Pediatr Otorhinolaryngol 1999;47:153–155.
Yoshinaga-Itano C: Benefits of early intervention for children with hearing loss. Otolaryngol Clin North Am 1999;32:1089–1102.
Yoshinaga-Itano C, Coulter D, Thomson V: The Colorado Newborn Hearing Screening Project: Effects on speech and language development for children with hearing loss. J Perinatol 2000;20(8, pt 2):S132–S137.
Young NM: Infant cochlear implantation and anesthetic risk. Ann Otol Rhinol Laryngol 2002;111(5, pt 2):49–51.
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