Cochlear Implant Candidacy

Getting Started	What is a CI?	Candidacy	Performance
Decision Making	Process	Insurance	Surgery
Education	Communication	Sign Language	Deaf Community
Speech Processor	Listening	Resources	Versión en Español

By Debra Nussbaum, M.A., CCC-A

A variety of requirements are considered for children in determining candidacy for a cochlear implant. These requirements continue to change, especially in relation to minimum age of implantation. Minimum age requirements continue to be reduced due to limited surgical risks and improved outcomes for children implanted at the youngest ages.

It is recommended that the candidacy process include a team approach that involves the family and professionals from both the medical and educational settings that are involved with the child. This will ensure that each child is an appropriate candidate for a cochlear implant, each family has realistic expectations regarding outcomes for the implant, and training and educational components are in place to assist in helping the child actualize benefit from the implant.

Obtaining accurate audiological information is at the core of making appropriate recommendations related to cochlear implant candidacy. While some audiological tests are more definitive and less objective than others, obtaining a precise description of a child's hearing level requires a comprehensive audiological test battery completed by an experienced pediatric audiologist. It is important that the audiologist on the implant team be experienced in fitting and facilitating hearing aid use, making recommendations related to cochlear implantation, and fitting of the implant device following implantation so that any decisions regarding implantation are made with complete information. For more information about hearing evaluations, see: Hearing Screening from the American Speech-Language-Hearing Association (ASHA) and/or ASHA’s Guidelines for the Audiologic Assessment of Children from Birth to 5 Years of Age (PDF).

Who Is a Candidate?

While each hospital implant center may have unique candidacy requirements, general candidacy issues for children are as follows:

In 2002, the Food and Drug Administration (FDA) lowered the recommended age requirement to 12 months of age. While this is the FDA-recommended age, this age is not legally binding and some hospital centers are completing the procedure earlier based on expectations of improved outcomes for early implantation. In addition, specific circumstances may allow for earlier implantation. For example, if meningitis is the cause of hearing loss, it may be important for the child to be implanted as early as possible as this condition causes ossification (bone build up) in the cochlea, making it increasingly difficult to surgically insert the electrode array as time passes. Note: There may be questions related to insurance payment for the procedure if it is completed prior to 12 months of age.
The FDA states that a child should have a bilateral (both ears), profound sensorineural hearing loss; however, increasing numbers of children with hearing loss in the severe range are being considered for cochlear implants.

Negligible functional benefit (limited open-set speech recognition) from appropriate amplification is often mentioned as a criterion. When such measures cannot be obtained on young children, hospital centers make individual decisions regarding whether or not a child would be able to do well on such tests given documented hearing levels and traditional hearing aids. There are varied implant center requirements regarding the use of traditional hearing aids prior to implantation. Some centers waive an extended hearing aid trial requirement in the interest of time when it is clear that the child would perform better with a cochlear implant.

A child who is failing to progress in speech, language, and listening development with traditional hearing aids based on parent reports and educational information, may be considered as a candidate.

Family willingness to follow recommendations; enroll in speech, language, and listening therapy; and return for follow-up appointments are factors in candidacy.

Having no medical contraindications to electrode insertion or receiver placement is a factor in candidacy.

Educational and home environments that are supportive of cochlear implants are factors in candidacy.

Who Is Not a Candidate?

Some characteristics of a child who may not be a candidate for a cochlear implant include:

a child that does not have the eighth nerve (auditory nerve) which carries sound from the cochlea to the brain as determined by a CAT scan (x-ray) and/or Magnetic Resonance Imaging (MRI) during the candidacy process. (See "What's Involved in the Process?" in Considerations in the Implantation Process.) and

a child who has significant residual hearing levels and receives good benefit from traditional hearing aid devices.

Other Factors Impacting Candidacy

Some hospital implant centers may also look at the following issues when determining candidacy:

For more information

Digital Hearing Aids: Current "State-of-the-Art"

Some centers may not implant children with severe emotional, behavioral, or cognitive delays when it is perceived that these characteristics may prevent participation in the educational/training programs necessary to actualize benefit from the cochlear implant.

Some children obtain substantial access to sound from the technology of state-of-the-art digital hearing aids or other hearing devices. Without surgical intervention, these devices may be an equally effective choice for some children.

While cochlear implants are typically used with individuals with sensori-neural hearing loss, use of a cochlear implant is also being considered as a possible intervention for children with auditory neuropathy/auditory dys-synchrony. The term "AN/AD" applies to patients who display auditory characteristics consistent with normal outer hair cell function and dys-synchronous responses of the eighth nerve (Hood, L., February 2002, Auditory neuropathy/auditory dys-synchrony: New insights.The Hearing Journal.)

Some cochlear implant centers strongly suggest participation in an oral educational setting. They may hesitate upon considering students and families that include sign language in their communication approach for their child. It's important that all involved persons are aware of the many factors in choosing a communication methodology/educational approach for children following cochlear implantation. (See Choosing an Educational Setting and Choosing a Communication Methodology.)

For additional information on candidacy requirements, see the following: