As part of the cochlear implant process, a pre-implant evaluation is necessary to determine if a child is a candidate for a cochlear implant. Assessments and procedures included in the evaluation should be conducted by a multidisciplinary team with experience in working with children who are deaf or hard of hearing.
- A typical pediatric implant team includes: Ear, Nose, & Throat (ENT) physician/surgeon, nurse, audiologist, and speech-language pathologist.
- The team may also involve other specialists such as an early interventionist, educational specialist, psychologist/counselor, social worker, neuropsychologist, and developmental pediatrician.
Pre-Implant Evaluation Process
Step 1: Cochlear Implant Orientation
The purpose of this is to orient a child and his or her family to the cochlear implant and the cochlear implantation process. Topics generally discussed with a family may include:
Step 2: Audiological Evaluation
As part of the pre-implant evaluation, an audiologist will measure the child's hearing levels. Testing will also be completed to see if amplification with appropriately fit hearing aids/hearing devices can provide enough auditory information.
Step 3: Medical Evaluation
An Ear, Nose, & Throat (ENT) surgeon determines if a child can safely undergo general anesthesia and reviews imaging such as a CT scan or an MRI to ensure that the cochleae are suitable for insertion of the electrode array. The physician will also look for any other medical conditions that would prevent the use of an implant.
Because children who have a cochlear implant are at a greater risk for contracting meningitis than children who do not have a cochlear implant, the physician will also ensure that the appropriate vaccinations for protection against pneumococcal bacteria have been ordered and completed.
The following links from the CDC.gov website may be helpful:
Step 4: Speech-Language Evaluation
A speech/language pathologist (SLP) conducts an evaluation that looks at the child's overall communication abilities, including receptive and expressive language, functional auditory skills, speech production and play skills. The SLP will also discuss the child's potential for growth in these areas.
A variety of tools may be used to gather this information including:
- Standardized tests
- Informal communication measures
- Parent questionnaires
The results of this evaluation are used to determine the child's areas of strength, to identify ways to help the child further develop communication skills, and to serve as a baseline from which to compare subsequent performance.
Step 5: Expectations Discussion
The purpose for discussing expectations is to determine if a family has an understanding of:
- The benefits and limitations of a cochlear implant device
- Realistic expectations for their child’s outcomes after receiving a cochlear implant
- Factors that can influence outcomes
Step 6: Vestibular Evaluation
Vestibular testing, which evaluates the balance system, may be requested to:
- Determine the health of a child's balance system
- Measure a baseline function to which future test results can be compared
Step 7: Psychosocial Evaluation
A psychosocial assessment looks at factors that can influence adjustment to or benefit from a cochlear implant. For instance, if family dynamics or behavioral problems present potential obstacles to success with a cochlear implant, appropriate intervention can be recommended or provided.
A psychosocial assessment might also be used to:
- Address questions about reasonable expectations
- Ensure that a child and/or family are highly motivated and willing to participate in an extended rehabilitation program
- Examine the potential candidate's cognitive abilities to rule out factors other than hearing loss, which may account for poor auditory and speech-language development.
Step 8: Neuropsychology Evaluation
Cochlear implant candidates may be referred for a neuropsychological evaluation if there is some concern about cognitive impairment that could impact the ability to actively participate in post-implant processes.
Step 9: Social Worker's Services
The social worker provides:
- Guidance and support to the child and the family
- Help with financial planning and exploring options for financial assistance
- Assistance with coordinating necessary appointments and services
- Counseling for families
Step 10: Cultural Viewpoints
For more information on varying cultural views of cochlear implantation, please visit the following websites:
