Changing Considerations for Cochlear Implant Candidacy: Age, Hearing Level and Auditory Neuropathy

The first child fitted with a cochlear implant was a ten year old boy of who received a single channel device from Dr. William House in 1980 (Eisenberg and House 1982; Eisenberg, Berliner, Thielemeir, Kirk and Tiber 1983). At that time the controversy over the safety and general wisdom of providing children with cochlear implants was raging. Prominent physicians and audiologists at the time, felt that cochlear implants were far too experimental and invasive to be used in vulnerable children. Less than 20 years later, the procedure is accepted as standard clinical practice and thousands of children under the age of 18 have received single and multichannel cochlear implants worldwide. In the 1980’s concerns over implantation of children included weighing the benefits of novice devices against the trauma of electrode insertion and issues surrounding head growth and device migration in young children. Many of these fears have been laid to rest and the benefits of cochlear implantation for aiding in speech perception, speech production and language development of children who are pre-lingually deaf, have been extensively documented. Twenty years after the first child was implanted, a major issue facing cochlear implant teams regarding candidacy is no longer “should we implant young children?” but “how young should we provide this intervention?” Information on neural plasticity and critical periods as well as the success of early intervention programs for remediation of many types of development disabilities has focused our attention on providing intervention for deaf children at the youngest possible age (see Sininger, Doyle and Moore 1999,