Is there a critical period for cochlear implantation in congenitally deaf children? Analyses of hearing and speech perception performance after implantation.

A range of basic and applied studies have demonstrated that during the development of the auditory system, early experimental manipulations or clinical interventions are generally more effective than those made later. We present a short review of these studies. We investigated this age-related plasticity in relation to the timing of cochlear implantation in deaf-from-birth children. Cochlear implantation is a standard intervention for providing hearing in children with severe to profound deafness. An important practical question is whether there is a critical period or cutoff age of implantation after which hearing outcomes are significantly reduced. In this article, we present data from prelingually deaf children (mostly congenitally deaf) implanted at ages ranging from 1 to 15 years. Each child was tested with auditory and speech understanding tests before implantation, and at regular intervals up to 8 years postimplantation. We measured the improvement in performance of speech understanding tests in younger implanted children and compared it with the results of those implanted at a later age. We also used a binary partitioning algorithm to divide the data systematically at all ages at implant to determine the optimum split, i.e., to determine the age at implant which best separates performance of early implanted versus later implanted children. We observed distinct age-of-implant cutoffs, and will discuss whether these really represent critical periods during development.