Paediatric cochlear implantation: current applications

Key words: Sensorineural hearing loss, Cochlear implantation, Hearing rehabilitation, Children

Cochlear implant is a partially implantable electronic device designed to provide profoundly deafened patients with hearing sensitivity within the speech range. Over the years patient candidacy has been expanded and the criteria for implantation continue to evolve within the paediatric population. The minimum age for implantation has progressively reduced; early intervention (12-18 months) and a short duration of auditory deprivation are associated with the best language acquisition results, taking advantage of sensitive periods of auditory development. When clinically appropriate, bilateral cochlear implantation should be considered for the advantages it offers in terms of sound localization and speech understanding in noisy environments. Deafened children with special clinical conditions, including inner ear malformation, cochlear nerve deficiency, cochlear ossification, and additional disabilities, can be successfully treated, even though they require an individualized candidacy evaluation and a complex post-implantation rehabilitation. Benefits from cochlear implantation include not only better abilities to hear and to develop speech and language skills, but also improved academic attainment, improved quality of life, and better employment status. Such rehabilitation technique is costs-saving by cutting educational costs and restoring the work productivity potential. Cochlear implants are considered to be standard of care in the treatment of children with severe to profound deafness; however, it is always necessary to bear in mind their limitations since these devices allow deaf people to become integrated in the hearing world but do not restore normal hearing. Researchers are looking for more sophisticated speech processing strategies as well as a more efficient coupling between the electrodes and the cochlear nerve with the goal of dramatically improving the quality of sound of the next generation of implants.