Factors influencing spoken language outcomes in children following early cochlear implantation.

Development of spoken language is an objective of virtually all English-based educational programs for children who are deaf or hard of hearing. The primary goal of pediatric cochlear implantation is to provide critical speech information to the child's auditory system and brain to maximize the chances of developing spoken language. Cochlear implants have the potential to accomplish for profoundly deaf children what the electronic hearing aid made possible for hard of hearing children more than 50 years ago. Though the cochlear implant does not allow for hearing of the same quality as that experienced by persons without a hearing loss, it nonetheless has revolutionized the experience of spoken language acquisition for deaf children. However, the variability in performance remains quite high, with limited explanation as to the reasons for good and poor outcomes. Evaluating the success of cochlear implantation requires careful consideration of intervening variables, the characteristics of which are changing with advances in technology and clinical practice. Improvement in speech coding strategies, implantation at younger ages and in children with greater preimplant residual hearing, and rehabilitation focused on speech and auditory skill development are leading to a larger proportion of children approaching spoken language levels of hearing age-mates.