Indications and counterindications for cochlear implantation in children

Objective: This study is aimed to analyze the current indications and count erindications 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 can didate selection; 2) age at implantation: 3) educational environment; and 4 ) associated handicapping conditions. Setting: Tertiary referral center with experience in CI since 1989 with inp atient and outpatient care. Intervention: All children received a Mini Nucleus 22 CI device (Cochlear L imited, Australia) in a standard surgical procedure. Results: Regarding auditory criteria, children with average hearing level o f 100-105 dB HL are more likely to obtain benefit from a CI than from a hea ring aid. The minimum age for CI should be as soon as there is a reliable d iagnosis of bilateral profound hearing loss, while the maximum age for CI d epends on strict selection criteria of candidates. The educational environm ent is of a great importance in the rehabilitation process, permitting a pr ogressive change to oral communication. Our experience in CI of children wi th multiple handicapping conditions is limited to a case of a deaf-blind ch ild who was implanted with a good performance. In the selection of these ch ildren 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, an d extensive neuropediatric and socioeducational evaluation.