A 14-month-old child with bilateral profound congenital sensorineural hearing loss has used appropriately fitted powerful hearing aids for more than three months with minimal benefit on aided audiometry and no speech development. What is the most appropriate intervention to optimise speech and language outcome?

• A Continue hearing aids until school age before considering surgery
• B Bone anchored hearing aid fitting
• C Sign language alone with reassessment at 5 years
• D Early cochlear implantation ✓

Explanation

Children with bilateral profound sensorineural hearing loss who derive limited benefit from a well fitted hearing aid trial are candidates for cochlear implantation, and earlier implantation, ideally within the first two years of life, exploits peak cortical auditory plasticity and gives markedly better speech and language outcomes. Deferring surgery to school age misses the critical window. Bone anchored devices suit conductive losses and cannot bypass a nonfunctioning cochlea.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.