What is the process for a child to get a cochlear implant?

Cochlear Implantation Process for Children

Cochlear implantation for children with profound bilateral sensorineural hearing loss should be considered when there is limited benefit from hearing aids (aided SII of only 25% bilaterally), with FDA guidelines recommending implantation as early as 12 months of age to maximize language outcomes. 1

Initial Assessment and Diagnosis

• Hearing Loss Identification:

  • Universal newborn hearing screening is essential for early detection
  • Children with suspected hearing loss require comprehensive audiologic evaluation
  • Normal developmental milestones for hearing response by age (2):
    • 0-4 months: Startle to loud sounds, quiet to mother's voice
    • 5-6 months: Localize sounds horizontally, begin imitating sounds
    • 7-12 months: Localize sounds in any plane, respond to name
    • 13-24 months: Follow directions, point to objects when asked

• Audiological Evaluation:

  • Auditory Brainstem Response (ABR) testing to confirm bilateral profound sensorineural hearing loss (unaided pure tone average >90 dB HL) 1
  • Assessment of residual hearing and speech recognition abilities
  • Evaluation of hearing aid benefit - limited benefit defined as aided SII of only 25% bilaterally 1

Cochlear Implant Candidacy Determination

• Primary Criteria:

  • Bilateral profound sensorineural hearing loss (>90 dB HL) 1
  • Limited benefit from appropriate hearing aids 1
  • Age ≥12 months (FDA guideline) 1
  • No medical contraindications

• Expanded Considerations:

  • Children with pure tone average >60 dB HL have a 75% chance of benefit over traditional amplification 3
  • More conservative criteria suggest children with PTA >82 dB HL have a 95% chance of benefit 3
  • Some children with asymmetric hearing loss or single-sided deafness may be candidates 4

Pre-Implantation Evaluation

• Multidisciplinary Team Assessment:

  • Otolaryngologist: Complete diagnostic assessment and surgical evaluation 2
  • Audiologist: Comprehensive hearing evaluation and hearing aid trial 2
  • Speech-Language Pathologist: Communication assessment 2
  • Psychologist: Cognitive and developmental assessment 1
  • Other specialists as needed (developmental pediatrician, neurologist) 2

• Medical Evaluation:

  • Complete otolaryngologic examination 1
  • Imaging studies (CT/MRI) to evaluate cochlear anatomy
  • Assessment for potential underlying causes of hearing loss 2

Surgical Procedure and Initial Activation

• Surgical Considerations:

  • Typically performed as outpatient procedure
  • Special considerations for infant anatomy when implanting children under 12 months 5
  • Initial healing period of 2-4 weeks before device activation

• Initial Activation:

  • Occurs 2-4 weeks post-surgery
  • Calibration of stimulation parameters to comfortable hearing thresholds 1
  • Establishment of baseline settings for the external sound processor 1

Post-Implantation Care and Rehabilitation

• Mapping and Programming:

  • Regular mapping sessions to adjust stimulation parameters 1
  • Frequent follow-up schedule:
    • Weekly to bi-weekly during first 1-2 months
    • Monthly for next 3-4 months
    • Quarterly for remainder of first year
    • Biannually after first year 1

• Auditory Therapy:

  • Intensive auditory therapy is essential to maximize benefit 1
  • Targeted phoneme training and speech recognition training 1
  • Family-centered approach with caregiver training 1

• Ongoing Monitoring:

  • Regular audiologic reevaluations to monitor progress 2
  • Speech and language development assessments 2
  • Middle-ear monitoring for complications like otitis externa 2

Outcomes and Benefits

• Language Development:

  • Earlier implantation (12-24 months) strongly associated with better language outcomes 1
  • Children implanted before 2.5 years typically make normal language progress but may retain a delay approximately equal to their age at implantation 3
  • Improved access to sound for development of spoken language skills 1

• Quality of Life:

  • Enhanced potential for age-appropriate language acquisition 1
  • Improved communication abilities and social integration 1
  • Reduced cognitive load and listening fatigue 1

Important Considerations

• The decision for cochlear implantation should be made based on a team evaluation including audiology, otology, psychology, and speech-language pathology 2
• Children with congenital cytomegalovirus (cCMV) may have additional considerations and require specialized care 2
• Bilateral implantation may provide additional benefits for sound localization and hearing in noise 1
• Children with single-sided deafness or asymmetric hearing loss should be evaluated on a case-by-case basis 4