Do Implants Fix Everything?

By Marlee Henderson and Heather Schieffler

Benefits of Cochlear Implants

The FDA approves of cochlear device implantation in children as young as 12 months old
and the large majority of children with cochlear implants (CIs) receive them as infants1. Research
has shown that CIs improve children’s ability to recognize and produce speech as compared to
their non-implanted peers who use hearing aids2. The improved speech recognition and
production skills provide the foundation for developing effective language, and literacy skills3,
and has lead to greater numbers of children with CIs being placed in mainstream schools with
their typically hearing peers1.

Limitations of Cochlear Implants

CIs convert sound waves to electrical signals and transmit them to the auditory nerve4.
While this allows people with CIs to hear sounds, it does not replace normal hearing because
subtle, but important, parts of the acoustic signal may not be transmitted by the CI5.

How Do These Limitations Affect School Performance?

To acquire language and literacy skills, children must master the basic components of

● speech sounds and the letters that represent them (phonology),
● use of small changes in language that alter the meaning of words (morphology),
● grammar (syntax),
● vocabulary (semantics),
● and the ability to use language socially and in conversation (pragmatics)6.

Speech Sounds

A phoneme is a single sound that can be perceived by speakers as the smallest unit
capable of changing the meaning of a word7. For example, changing the c in cat to a b changes
the word and its meaning. It is necessary that children develop sensitivity to phonemic structure
in order to correctly perceive and understand speech. Sensitivity to phonemic structure is also
necessary to learn to read because the letters of the alphabet largely represent individual
phonemes3. Since the sound signal provided by CIs is altered in quality, it’s easy to see how missing even small amounts of acoustic information can have a domino-like effect on multiple
language and literacy skills.

Units of Meaning and Their Connection to Grammar

Morphology is the use of phonemic relationships to create units of meaning, like -ed,-ing,
-s7. The knowledge of morphology assists in phonological processing, which is the ability to
recognize phonemes in order to process spoken or written language7. Children who receive a CI
prior to 24 months of age are shown to use units of meaning and grammar more appropriately
than those who receive an implant later in life8. Children with CIs are able to identify units of
meaning, but they may have difficulty understanding how to use them properly6.

Vocabulary Development with Implants

The ability to learn words is dependent on the ability to perceive phonological
differences. As such children with CIs may have slowed vocabulary growth and more limited
vocabulary skills than their normal hearing classmates5.

Conversational Abilities of Children with Implants

Conversation is a joint activity requiring the speaker and listener to understand,
comprehend, and produce messages amongst themselves9. Children 8-12 year-old with CIs
demonstrate deficits in social communication when compared to their normally hearing peers3.
Conversation may highlight deficits that children with CIs present with, and clarifications may
be requested continuously throughout conversation9. Since children with CIs may have delayed
language, it is easy to see why their conversational skills may be inappropriate, and therefore

In Conclusion

Research suggests that cochlear implants enhance auditory capacity and consequently
improve the development of language, but that these children continue to encounter difficulty in
the acquisition of age appropriate spoken-language skills9.
Language based intervention may be efficient in assisting children with CIs in the
acquisition of spoken-language since they are likely to demonstrate difficulties in this area9.


1Chute, P. (December, 2008). Cochlear implants in the classroom: The role of the educational audiologist. Retrieved from

2American Academy of Audiology. (n.d.). Cochlear implants in children. Retrieved from https://

3Nittrouer, S., & Caldwell-Tarr, A. (2016) Language and literacy skills in children with cochlear
implants: Past and present findings. In N. Young, & K. Kirk (Eds.), Pediatric cochlear
implantation: Learning and the brain (pp.177-198). doi:10.1007/978-1-4939-2788-3

4American-Speech Language-Hearing Association. (n.d.). Cochlear implants. Retrieved from

5Nittrouer, S., Sansom, E., Low, K., Rice, C., & Caldwell-Tarr, A. (2014). Language structures
used by kindergartners with cochlear implants: Relationship to phonological awareness,
lexical knowledge and hearing loss. Ear and Hearing, 35(5), 506–518.

6Guasti, M. T., Papagno, C., Vernice, M., Cecchetto, C., Giuliana, A., & Burdo, S. (2014). The
effect of language structure on linguistic strengths and weaknesses in children with
cochlear implants: Evidence from Italian. Applied Psycholinguistics, 35(4), 739-764. doi:

7Nelson, W. N. (2010). Language and literacy disorders: Infancy through adolescence. Boston,
MA: Pearson.

8López-Higes, R., Gallego, C., Martín-Aragoneses, M. T., & Melle, N. (2015). Morpho-syntactic
reading comprehension in children with early and late cochlear implants. Journal of Deaf
Studies and Deaf Education, 20(2), 136. Retrieved from

9Toe, D. M., & Paatsch, L. E. (2013). The conversational skills of school-aged children with
cochlear implants. Cochlear Implants International: An Interdisciplinary Journal, 14(2),
67-79. doi:10.1179/1754762812Y.0000000002