Cochlear Implant Candidacy

Criteria for Cochlear Implantation in Children

Hearing Aid Trial

  • In general, it is recommended that a child be appropriately fit with hearing aids and use them for 3-6 months before determining implant candidacy.
  • In cases of meningitis, a shorter hearing aid trial is recommended. Sometimes the trial is waived as bony growth in the cochlea following meningitis may create problems for implantation.
  • In ​cases of meningitis, the physician may proceed with implantation prior to the child reaching 9-12 months of age. This is to ensure adequate insertion of the electrodes into the cochlea, before the bony growth fills the cochlea.

Degree of Hearing Loss

  • Children between 9 months and 18 months of age: Profound sensorineural hearing loss of 90 decibels or greater in both ears.
  • Children 24 months of age and older: Severe-to-profound sensorineural hearing loss of 70 decibels or greater in both ears.

Lack of Benefit from Appropriately Set Hearing Aids

Examples of this would include:

  • Inconsistent response to his/her name in quiet environment
  • Failure to alert to environmental sounds while wearing amplification

No Medical Contraindications

Contraindications that may prevent or delay implantation or may alter expectations for long-term outcomes include:

  • Absence of the auditory nerve
  • Medical conditions or developmental delays that would severely limit participation in aural habilitation
  • Active middle ear infections.

Environment: Educational & Home

Children should be in a rehabilitative or educational setting where the development of auditory (listening and spoken language) skills are emphasized. Rehabilitative or educational environments that encourage auditory skill development have a positive effect on the child’s progress.

Other important factors that are considered include:

  • High motivation on the part of family and/or primary caregivers to promote language and learning
  • Commitment to hearing device use
  • ​Positive family environment
  • Realistic expectations​​

Ever Changing Criteria

The criteria to determine candidacy for cochlear implants have changed a great deal since the devices were first introduced. Recently, the Food and Drug Administration (FDA) approved specific cochlear implant devices for children as young as 9 months of age. The FDA also recently approved the use of specific devices for individuals with single sided deafness or asymmetric hearing loss.