Perspectives On Cochlear Implantation for Children;

• Many cochlear implant centers and hospitals recommend parents and older children receiving a cochlear implant be given a statement of understanding. For example, the parent or person receiving the implant should be given information about:
• cochlear implants, their features and functionality;
• how to care for cochlear implants;
• surgical procedures, including pre and post surgery information;
• risks during surgery;
• the level of commitment necessary for developing listening and speaking;
• the need for consistent habilitation;
• a family’s responsibility for supporting the child in the home;
• mapping, including different strategies and capabilities the implant;
• immunization requirements;
• realistic expectations for the individual child;
• parent expectations;
• potential outcomes for listening and language development, which may depend on the age and hearing history of the child.


• Parents should understand that the use of a cochlear implant device is an option for severe to profoundly deaf person. For persons choosing listening and spoken language as their main mode of communication, the purpose and goal of an implant is to develop listening skills with measurable outcomes for spoken language.


• Parents of very young children may choose the implant as an option for developing their child’s listening and spoken language. Older children understanding this option may be part of the decision.


• The American National Standards Institute requires that Soundfield audiometric testing be performed under strict, calibrated conditions. Persons interested in cochlear implants must receive professional audiometric testing and evaluation. Children as young as 12 months can receive an implant. Hospitals may have slightly different standards for degree of loss or age of implant candidacy: consult with your doctor.


• Hearing aid technology has improved drastically over the past decade, and considerations for a cochlear implant must include the opportunity for profoundly deaf persons to experience or attempt, good hearing amplification before implantation. The determination of “hearing benefit” combines information and results from parents, speech and language therapists, auditory-verbal specialists, and experienced audiologists who can perform speech and word recognition tests in addition to aided and unaided audiometric testing in sound proof rooms. In other words, we want to know if the child considering an implant has little or no benefit from amplification.


• There is universal understanding that the earlier a child receives access to language rich environment, the more normal that child will develop the critical cortical (brain) functions of language (i.e. attention, vocabulary, turn taking, talking, etc.). It is also known that the critical age for developing language is between birth and 3-5 years of age. Constant use and practice listening with a cochlear implants is necessary to achieve good spoken language outcomes.


• Persons choosing a cochlear implant for their child may need to focus auditorily if they want to achieve the maximum benefit and outcomes for listening and speaking. This auditory verbal approach (habilitation) is necessary for very young children receiving the implant if optimizing the implant is desired. Some questions for parents to ponder are:
• Has your child ever experience good hearing technology?
• Has your child had a history of listening and language support?
• Has your child ever been exposed to sound before?
• Do you have a strong family commitment to habilitation?
• Does your family have strong realistic expectations?
• Do you understand your child’s hearing and audiological history?
• Who will pay for the implant, surgery, parts replacement, and habilitation?
• Who will provide on-going device programming (called mapping),
• Does the person receiving the implant want the implant?
• Do you have a specialist who can provide individual therapy on a regular basis?


• Before implantation, a family and their child may experience any of the following evaluations:
• Examination and consultation with cochlear implant surgeon.
• Complete Audiological evaluation, including a complete medical history of child’s hearing and auditory support services;
• Speech and Language evaluation;
• Psychological Review and evaluation of the child;
• Interview of family by trained psychologist;
• Physical exam by pediatrician;
• CT scan and MRI.


• It is essential that parents ensure a team of qualified and experienced people are available to support their child, both before and after consideration for implantation. A “team” may consist of the following people: parent(s), caregivers, the child’s teacher, Speech and Language and/or Auditory-Verbal specialists, family members, special education specialists, and an audiologist or doctor. Members of the team should meet periodically to discuss the child’s needs, especially for aural habilitation. Parent concerns and questions must be heard and discussed!


• If the decision is to proceed with cochlear implantation, the team must work cooperatively to develop a “plan” for developing listening and spoken language outcomes. This includes both individual therapy and support in the home, and should include auditory goals and o objectives, as well as spoken language targets. The more intense the program, the better potential for listening and spoken language outcomes.