Controversial Statement Basis of 3 month old Implanted

Ossification (new bone growth) of the cochlea is one of the leading reasons why insurance has been approving coverage for babies to be implanted with a cochlear implant prior to 12 months even though it is not FDA approved. When a child becomes deaf after acute bacterial meningitis (ossification of their cochlea), it is believed by some doctors and audiologists that “rapid obliteration of the cochlea” is a justifiable cause to implant a child prior to 12 months. The leading study that has been the foundation of this claim happened in 1997 and had only one child documented in the study.

“A case is described of a child of 2.6 years who developed total deafness after acute bacterial meningitis. Rapid obliteration of the cochleas due to osteoneogenesis led to limited cochlear implantation. The case is made for fast tracking these children to cochlear implant teams before neo-ossification becomes established.”

In April of 2018, at the young age of 3 months and 1 day, Kadence Lane made history for being the youngest patient ever to receive a cochlear implant at the University of Mississippi Medical Center and among the youngest in the world. Kadence, like other babies younger than 12 months, had contracted meningitis at 2 months old and had “rapid hearing loss” (Clarion Ledger)

In this same article, ossification of the cochlea is listed as the very reason this 3 month old was implanted when she was, “The danger, for Kadence, was in the ossification that occurs in the cochlea, the part of the inner ear involved in hearing.” (Clarion Ledger)

Dr Jeff Carron was quoted in the Clarion Ledger with a sense of urgency:

“That’s why there was a rush to do something quickly,” Carron said. “It most likely would have been impossible for her hearing to be saved if we had waited.”

In other words, parents needed to be told that doctors would have to act fast. Once complete ossification occurred, “Kadence would no longer benefit from a hearing aid or a cochlear implant, and that could happen in both cochlea in as little as a month.” (Carron)

This was the same type of approach the doctor in the UK who implanted a child at 3 months 3 days old had about the sense of urgency behind ossification. “Hearing impairment is a sensory disability that affects millions of people all over the world. Though not life-threatening, it can become a major burden in social and professional life. In the industrialized world, deafness of infective and/or environmental origin has become less frequent, with a consequent rise in the proportion of hereditary hearing impairment.” (UK Study)

Joy Maynard, an audiologist was contacted for further information and she verified that ossification does occur over time in babies who became deaf because of meningitis. She also clarified that implantation at 3 months to prevent further ossification is not research-based.

The problem is that the number of children who become profoundly Deaf from meningitis is very small in the bigger picture of the discussion of implantation of babies under the age of 12 months. They're using a rare example to generalize and rationalize why implanting babies younger than 12 months should be the new standard of care.

There was a time when more babies were getting meningitis, but the incidence rate of that is currently low. The other problem with the 1997 study is that it was a single case. “While ossification is definitely a side effect of meningitis, using one example to then try to establish a new criteria is not sound.” Maynard