American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

Abstract

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Hearing Thresholds, Speech Recognition, and Audibility as Indicators for Modifying Intervention in Children With Hearing Aids

“…FDA guidelines for pediatric cochlear implantation children are even more conservative, suggesting candidates for CI should have word recognition scores of 30% or less (Park et al 2021a). It should be noted that neither guideline specify listening condition (i.e., quiet or noise; Warner-Czyz et al 2022). On the other hand, the Pediatric Minimum Speech Test Battery suggests that 80% on a given speech recognition in quiet or in noise task represents ceiling or mastery (Uhler et al 2017).…”

Don’t Defer, Please Refer! Cochlear Implantation Candidacy as Part of the Hearing Health Care Continuum

“…Recently, the American Cochlear Implant Alliance published similar recommendations for pediatric patients (see Table 1). 11…”

Cochlear Implantation in Children With Hearing Impairment

“…American Cochlear Implant Alliance Task Force recommended a 50/70+ guideline for referral to pediatric CI candidacy. That is, clinicians should refer pediatric patient for evaluation if they meet any of the following criteria: appropriately selected word recognition scores <50% correct; unaided pure-tone thresholds > 70 dB HL; or poor functional performance, limited progress in language or auditory development, or poor quality of life (Warner-Czyz et al, 2022). Referral for consideration of cochlear implant has evolved over the years.…”