American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

Abstract

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child's skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Fig. 1.

Schematic for determination of CI candidacy. CI indicates cochlear implant.

Fig. 2.

Professionals associated with a multidisciplinary team to determine pediatric CI candidacy. CI indicates cochlear implant.

Fig. 3.

Speech perception measures that comprise the Pediatric Minimum Speech Test Battery by Uhler et al. (2017). Gray boxes indicate closed-set measures. Baby Bio indicates Pediatric AzBio test; BKB-Quiet, Bamford-Kowal-Bench test in quiet; BKB-SIN, Bamford-Kowal-Bench Speech-in-Noise test; CNC, Consonant-Nucleus-Consonant test; ESP, Early Speech Perception test; LNT, Lexical Neighborhood test; MLNT, Multisyllabic Lexical Neighborhood Test; PSI, Pediatric Sentence Intelligibility test.

Fig. 4.

Summary of guidelines for pediatric amplification. This figure is adapted from the American Academy of Audiology (2013) practice guideline on pediatric amplification, focusing on prescriptive formulae, verification, and validation of hearing aid fittings.