Technology Alone Cannot Promote Optimal Childhood Development—Why Cochlear Implantation Must Be Accompanied by Social Intervention

Cochlear implants are among the most transformative biomedical technologies ever invented. When harnessed during the unparalleled period of neuroplasticity in early childhood, cochlear implants can revolutionize the language and academic development of children born deaf or hard of hearing, presenting them the option to achieve outcomes comparable to their hearing peers.

Yet, there are limitations to technology’s impact on human development; auditory access alone is insufficient to unlock every child’s full potential. In fact, patients’ outcomes vary dramatically. In JAMA Otolaryngology-Head & Neck Surgery, Mueller et al. explore those disparities and quantify the link between children’s socioeconomic conditions and their post-implant outcomes. In this systematic review and meta-analysis of 20 studies comprising 1905 children, Mueller et al2 found that while low socioeconomic status (SES), parental education, and parental involvement were significantly associated with a patient’s postimplant language outcomes (β = −0.47 [95% CI, −0.83 to −0.10]; β = 0.45 [95% CI, 0.29-0.62]; β = 0.30 [95% CI, 0.13-0.48], respectively), age of implantation did not hold the same significance (β = −0.30 [95% CI, −0.43 to −0.17]). This is a surprising finding, given the field’s emphasis on early implantation (though most included studies had a mean age of implantation >2 years). Together, these results underscore the powerful impact of social determinants of health on a child’s postimplant development and the importance of addressing those factors with targeted interventions, just as the child’s sensorineural hearing loss is addressed with cochlear implantation.