Communication Development in Children Who Receive a Cochlear Implant by 12 Months of Age *†§Jaime Leigh, †§Shani Dettman, *†§Richard Dowell, and *‡§Robert Briggs *Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; ÞDepartment of Audiology and Speech Pathology, þDepartment of Otolaryngology, and §HEARing Cooperative Research Centre, The University of Melbourne, Melbourne, Victoria, Australia Objective: Describe the long-term benefits of early cochlear implantation. Provide a comprehensive description of outcomes, including: language, speech production, and speech perception. Compare the communication outcomes for the early implanted children to those of normally hearing children and children who received a cochlear implant at a comparatively older age. Method: Retrospective review of the communication develop- ment of 35 children implanted between 6 and 12 months of age and 85 children implanted between 13 and 24 months of age. Audiologic assessments included unaided and aided audiograms, auditory brainstem response (ABR), auditory steady state re- sponse (ASSR), and otoacoustic emissons (OAEs). Formal lan- guage, speech production, and speech perception measures were administered, preimplant and at 1, 2, 3, and 5 years postimplant. Results: The children who received their cochlear implant by 12 months of age demonstrated language growth rates equiv- alent to their normally hearing peers and achieved age ap- propriate receptive language scores 3 years postimplant. The children who received their cochlear implant between 13 and 24 months demonstrated a significant language delay at 3 years postimplant. Speech production development followed a similar pattern to that of normal-hearing children, although was delayed, for both groups of children. Mean open-set speech perception scores were comparable with previous reports for children and adults who use cochlear implants. Conclusion: Children implanted by 12 months of age demon- strate better language development compared with children who receive their cochlear implant between 13 and 24 months. This supports the provision of a cochlear implant within the first year of life to enhance the likelihood that a child with severe-to-profound hearing impairment will commence elementary school with age- appropriate language skills. Key Words: ChildrenVCochlear implantsVEarly implantationVHearing impairmentVInfantsV OutcomeVUnder 12 months. Otol Neurotol 34:443Y450, 2013. The extent to which a child will use the auditory in- formation provided by a cochlear implant to develop oral speech and language skills is affected by factors the child brings to the learning environment, characteristics of the child’s intervention program and characteristics of the family that affect the child’s learning. Numerous studies have attempted to identify the factors that affect speech perception and language outcomes for children using cochlear implants. These include the following: age at onset of hearing loss (1Y4), degree of preimplant resid- ual hearing (5Y9), presence of a developmental delay (10Y14), sex (15), age at identification of hearing loss (16Y20), age at cochlear implantation (21Y31), educa- tional placement/mode of communication (23,32), and family characteristics and participation in the intervention program (33Y38). For the purpose of the present study, age at implantation is the primary factor of interest. The remaining factors will be controlled through selection criteria or discussed as part of the investigation. Access to the sounds of speech during the early years of life is crucial for the optimal development of oral speech and language. Children with significant hear- ing loss, defined as hearing impairment of greater than 40 dBHL in both ears (39), are at high risk of developing a speech and language delay if the appropriate interven- tion is not sought as early as possible. Central to the argu- ment of ‘‘the earlier the better’’ for intervention in hearing impaired children are the concepts of auditory deprivation and critical periods for language development. The absence of sound input during the first few years of life can result in irreversible changes to the auditory cortex. The developing auditory system is maximally Address correspondence and reprint requests to Jaime Leigh, MClAud, Cochlear Implant Clinic Royal Victorian Eye and Ear Hospital 32 Gisborne Street East Melbourne VIC 3002 Australia; E-mail: jleigh@ unimelb.edu.au Support: Financial support for this work was provided by The Uni- versity of Melbourne, Department of Audiology and Speech Pathology and The Royal Victorian Eye and Ear Hospital, Melbourne. Otology & Neurotology 34:443Y450 Ó 2013, Otology & Neurotology, Inc. 443 Copyright © 2013 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.