title: What is the optimal timing for bilateral cochlear implantation in children?
abstract: Bilateral cochlear implants (CIs) have been provided to children who are deaf in both ears with intent to promote binaural hearing. If it is possible to establish binaural hearing with two CIs, these children would be able to make use of interaural level and timing differences to localize sound and to distinguish between sounds separated in space. These skills are central to the ability to attend to one particular sound amidst a number of sound sources. This may be particularly important for children because they are typically learning and interacting in groups. However, the development of binaural processing could be disrupted by effects of bilateral deafness, effects of unilateral CI use, or issues related to the child's age at onset of deafness and age at the time of the first and second cochlear implantation. This research aims to determine whether binaural auditory processing is affected by these variables in an effort to determine the optimal timing for bilateral cochlear implantation in children. It is now clear that the duration of bilateral deafness should be limited in children to restrict reorganization in the auditory thalamo-cortical pathways. It has also been shown that unilateral CI use can halt such reorganization to some extent and promote auditory development. At the same time, however, unilateral input might compromise the development of binaural processing if CIs are provided sequentially. Mismatches in responses from the auditory brainstem and cortex evoked by the first and second CI after a long period of unilateral CI use suggest asymmetry in the bilateral auditory pathways which is significantly more pronounced than in children receiving bilateral implants simultaneously. Moreover, behavioural responses to level and timing differences between implants suggest that these important binaural cues are not being processed normally by children who received a second CI after a long period of unilateral CI use and at older ages. In sum, there may be multiple sensitive periods in the developing auditory system, which must be considered when determining the optimal timing for bilateral cochlear implantation.
authors.affiliation: Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada. karen.gordon@utoronto.ca
authors.forename: K A
authors.initials: KA
authors.lastname: Gordon
authors.forename: S
authors.initials: S
authors.lastname: Jiwani
authors.forename: B C
authors.initials: BC
authors.lastname: Papsin
mesh_terms: D000367:Age Factors; D001306:Auditory Pathways / Q000503:physiopathology; D001309:Auditory Threshold; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D003054:Cochlear Implants; D003638:Deafness / Q000175:diagnosis / Q000601:surgery*; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D013067:Speech Perception; D013997:Time Factors; D016896:Treatment Outcome