Pediatric Cochlear Implantation
Pediatric cochlear implantation has transformed the opportunity for children with severe to profound sensorineural hearing loss to acquire listening and spoken language. A multidisciplinary team effort, specialized skills, and timely coordination are critical to the successful achievement of these goals, starting from the determination of candidacy to the delivery of services, as well as transitions through various stages of language acquisition and educational settings. The candidacy process includes the characterization of auditory dysfunction and the evaluation of comorbidities and the peripheral auditory anatomy that may impact the feasibility and safety of the surgical intervention. The establishment of reasonable family goals and expectations provides an important roadmap for sustained commitment to the long habilitation process. The pediatric implant surgeon must have knowledge of the unique surgical challenges including inner ear malformations and the prevention and management of wound and device complications. The facility must be equipped to carry out play audiometry and the technical aspects of device programming in order to achieve a functional map in a young child. Consistent and frequent rehabilitation sessions and parent coaching after surgery are necessary to build a strong language scaffold. Close collaboration between surgeon, audiologist, auditory therapist, and educator is required to optimize sensory input and access to speech in the therapeutic and educational settings. In addition to age at implantation, parental sensitivity to the language learning needs of their child is an important determinant of language achievement in children with cochlear implants. Increased attention to the needs of families as the primary source of language input to an infant or toddler offers additional opportunity for enhancing outcomes.
