Language and educational attainment were evaluated over a 4-year period in 8 profoundly deaf, orally trained child users of the Nucleus multichannel implant with the spectral peak (SPEAK) processor. The average age at implantation was 5.8 years. In terms of audition and language, these children resembled severely deaf children, with unaided hearing losses in the region of 70 to 75 dB, who use hearing aids. In tests of educational attainment and literacy, average performance lagged behind grade placement by an amount that increased with increasing language demand of the task. The benefits of implantation are considerable; nevertheless, auditory limitations, combined with language deficits already present at the time of implantation, present a continuing educational challenge. Earlier implantation, when the auditory system is more plastic and language delays are automatically minimized, may well produce better outcomes, but this advantage remains to be demonstrated.
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