Supporting Communication in Infants with Hearing Loss Prior to Cochlear Implantation

By Megan Y. Roberts

This article is a part of the January/February 2017, Volume 29, Number 1, Audiology Today issue.

A baby fails a newborn hearing screening and an auditory brainstem response (ABR) indicates profound bilateral hearing loss. From an audiologist’s perspective, fitting for hearing aids and an evaluation for cochlear implant candidacy are often the next steps. But for parents the lag time between identification and implantation is often a stressful time that involves waiting and worrying. This lag, during which infants do not have access to auditory linguistic input, occurs during a sensitive period of prelinguistic communication development (Ruben and Schwartz, 1999). What can pediatric audiologists and early intervention providers do during this critical period of development? The results of the first clinical trial (NCT01963468) of a pre-implantation communication treatment (PICT) allow us to answer this question.

Persistent language delays following early implantation suggest a cochlear implant alone is insufficient for normal language skills post-implantation (Niparko et al, 2010). But waiting to initiate communication treatment until after the cochlear implant may be too late, given the critical period for language development (Ruben and Schwartz, 1999).

Effective early communication intervention delivered prior to implantation may be necessary to reduce such delays. Because infants do not have access to sound during this period, they may require additional support to acquire prelinguistic communication and language skills (Ruben and Schwartz, 1999).

Early in life, infants and parents engage in interactions that form the foundation for language learning. When an infant is born with a hearing loss, these interactions are altered in two primary ways. First, hearing loss limits the amount of access to spoken language. Second, given that 90 percent of children with hearing loss are born to hearing parents, a hearing status mismatch between the parent and the child may result in communication interaction difficulties. Hearing parents, limited by their own communicative experience which is different than that of their infant, may have difficulty tailoring interactions to meet their infant’s learning needs. For example, hearing parents may use fewer visual strategies (Waxman and Spencer, 1997) and may be more directive (Fagan et al, 2014). These increased directive behaviors may result in fewer infant-parent interactions (Gale and Schick, 2009).