Statement topic

Action recommendation

Level of evidence

Strength of recommendation.

Study

Type

Reference

1. Etiology

Perinatal problems, such as meningitis, hyperbilirubinemia, and other aetiologies associated with sensorineural hearing loss may affect candidacy and predict post-operative outcomes. Information should be documented clearly in the case history.

 High

Strong recommendation

Systematic review

1, 20

2. Duration of deafness

Duration of deafness can affect candidacy and predict post-operative outcomes. Information should be documented clearly in the case history

 High

Strong recommendation

Systematic review

2, 19

3. Hearing aid use prior to implantation

Hearing aid use prior to implantation can affect candidacy and predict post-operative outcomes. Information should be documented clearly in the case history.

High

Strong recommendation

Systematic review

7, 20

4. Age at implantation

Age at implantation can affect candidacy and predict post-operative outcomes. Information should be documented clearly in the case history.

High

Strong recommendation

Systematic review

 3, 4

5. Prelingually deafened adults

Prelingually deafened adolescents and adults may benefit from cochlear implantation and should not be excluded from candidacy. Families should be counseled regarding realistic expectations.

Low

Conditional recommendation

Cohort studies

7, 21

6. Other disabilities

Children with disabilities in addition to deafness may benefit from cochlear implantation in quality-of-life outcomes and environmental awareness. These groups should not be excluded from candidacy. Families should be counseled regarding realistic expectations

High

Strong recommendation

Systematic review

 8, 15

7. Assessment

Audiometric threshold testing is used to determine candidacy; better pre-operative hearing thresholds are associated with better post-operative outcomes in children and prelingually deafened adults.

High

Strong recommendation

Systematic review

10,12

8. Assessment

Cognitive evaluation or cognitive screener should be considered when evaluating children and older adults.

Very Low

Strong recommendation

Expert opinion

30,32

9. Assessment

A speech and language evaluation may be recommended in adult candidacy evaluations and could be considered critical in pediatric candidacy evaluations.

High

Strong recommendation

Systematic review

8

10. Expectations

Counseling toward appropriate expectations should be done by the audiologist and the phoniatrician.

Moderate

Strong recommendation

Systematic review

8

11. Follow up assessment

For children, evaluation of audibility and auditory, speech, and language development should be conducted routinely throughout development. More frequent monitoring of progress is warranted in those children who are in the period of developing language and auditory skills.

Low

Strong recommendation

Cohort studies

4

12. Follow up assessment

Informational and adjustment counselling should be provided to support consistent device use, implementation of intervention strategies, and psychosocial well-being .

Low

Strong recommendation

Cohort studies

32

13. Consistent use of CI

High performance in children who use a cochlear implant has been linked to full-time use of the cochlear implant in home and school environments.

High

Strong recommendation

Randomized control trial

14

14. Bilingualism

Individuals who use cochlear implants can experience success in using multiple languages.

Moderate

Strong recommendation

Randomized control trial

6

15. Assisstive hearing technology

All individuals who use a cochlear implant should be considered as a potential candidate for hearing assistive technology; particularly those who experience complex listening environments and school-aged children.

High

Strong recommendation

Systematic review

31

16. Intervention

Intervention for adults may focus on auditory training. The specific intervention needs may vary based upon factors known to affect outcomes.

High

Strong recommendation

Systematic review

18

17. Intervention

The amount and quality of language used by parents/caregivers of children who use cochlear implants has a strong influence on these children’s linguistic development.

Moderate

Strong recommendation

Randomized control study

13

18. Intervention

Engaging family members in therapy and coordinating efforts among therapists and educators is believed to result in the best outcomes for children and families

Moderate

Strong recommendation

Randomized control study

2

19. Intervention

The likelihood of a child gaining high benefit in the areas of speech perception, speech production, and spoken language increases when more emphasis is placed on listening and spoken language in the child’s home and educational setting .

High

Strong recommendation

Randomized control study

9

20. Intervention with other disabilities

The progress of children with other comorbidities should be measured by criteria that are unique to them and that reflect the goals of the family.

High

Strong recommendation

Randomized control study

17

21. Intervention

Bilateral stimulation should be considered for all individuals who use a cochlear implant, if not otherwise contraindicated.

High

Strong recommendation

Randomized control study

11