*Article* **Development of Sound Localization in Infants and Young Children with Cochlear Implants**

**Filip Asp 1,2,\*, Eva Karltorp 1,2 and Erik Berninger 1,3**


**\*** Correspondence: filip.asp@ki.se

**Abstract:** Cochlear implantation as a treatment for severe-to-profound hearing loss allows children to develop hearing, speech, and language in many cases. However, cochlear implants are generally provided beyond the infant period and outcomes are assessed after years of implant use, making comparison with normal development difficult. The aim was to study whether the rate of improvement of horizontal localization accuracy in children with bilateral implants is similar to children with normal hearing. A convenience sample of 20 children with a median age at simultaneous bilateral implantation = 0.58 years (0.42–2.3 years) participated in this cohort study. Longitudinal followup of sound localization accuracy for an average of ≈1 year generated 42 observations at a mean age = 1.5 years (0.58–3.6 years). The rate of development was compared to historical control groups including children with normal hearing and with relatively late bilateral implantation (≈4 years of age). There was a significant main effect of time with bilateral implants on localization accuracy (slope = 0.21/year, R<sup>2</sup> = 0.25, F = 13.6, *p* < 0.001, *n* = 42). No differences between slopes (F = 0.30, *p* = 0.58) or correlation coefficients (Cohen's q = 0.28, *p* = 0.45) existed when comparing children with implants and normal hearing (slope = 0.16/year since birth, *p* = 0.015, *n* = 12). The rate of development was identical to children implanted late. Results suggest that early bilateral implantation in children with severe-to-profound hearing loss allows development of sound localization at a similar age to children with normal hearing. Similar rates in children with early and late implantation and normal hearing suggest an intrinsic mechanism for the development of horizontal sound localization abilities.

**Keywords:** sound localization; infants; bilateral cochlear implants; development
