Indications and counterindications for cochlear implantation in children

OBJECTIVE
This study is aimed to analyze the current indications and counterindications of cochlear implantation (CI) in children.

STUDY DESIGN
This study reviews the children implanted in our institution looking specifically at the following aspects: 1) auditory criteria for candidate selection; 2) age at implantation; 3) educational environment; and 4) associated handicapping conditions.

SETTING
Tertiary referral center with experience in CI since 1989 with inpatient and outpatient care.

INTERVENTION
All children received a Mini Nucleus 22 CI device (Cochlear Limited, Australia) in a standard surgical procedure.

RESULTS
Regarding auditory criteria, children with average hearing level of 100-105 dB HL are more likely to obtain benefit from a CI than from a hearing aid. The minimum age for CI should be as soon as there is a reliable diagnosis of bilateral profound hearing loss, while the maximum age for CI depends on strict selection criteria of candidates. The educational environment is of a great importance in the rehabilitation process, permitting a progressive change to oral communication. Our experience in CI of children with multiple handicapping conditions is limited to a case of a deaf-blind child who was implanted with a good performance. In the selection of these children it is mandatory to have extensive multidisciplinary evaluation.

CONCLUSIONS
An experienced team is needed in the selection of children for CI. Candidates should meet anatomic criteria, have a reliable diagnosis of bilateral profound hearing loss, an evaluation of communication skills, and extensive neuropediatric and socioeducational evaluation.

CITA DEL ARTÍCULO Am J Otol. 1998 May;19(3):332-6