Guideline on Cochlear Implants

Acta Otorrinolaringologica Espanola

Manrique, M., Ramos, A., et al. (2019).

Acta Otorrinolaringologica Espanola, 70(1), 47-54.

This guideline from the Scientific Committees of Otology, Otoneurology, and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), provides recommendations to medical specialists, health authorities, and the general public on cochlear implantation in children and adults.

Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC)

"Children with severe-profound pre or post-lingual bilateral sensorineural hearing loss should receive, health permitting, a simultaneous bilateral implantation. In the case of sequential implantation in children the second implant must be undertaken if possible, within an interval of under one year" (p. 50). The interval between implants should be no more than 5 years.

For adults with post-lingual, severe to profound sensorineural hearing loss, sequential cochlear implantation (CI) should occur after the first CI has been used for at least one year.

Children with hearing loss may be candidates for cochlear implantation (CI) if they demonstrate the following criteria: <ul> <li>a severe (71-90 dB hearing loss [HL]) to profound (greater than 90 dB HL), bilateral sensorineural hearing loss in conversational frequency range (500-4000 Hz);</li> <li>no benefit achieved from a hearing aid after a three to six month trial period (unless contraindicated);</li> <li>confirmation of the presence of the cochlear nerve and the viability of electrode insertion;</li> <li>a diagnosis of meningitis requiring emergency implantation due to risk of ossifying labyrinthitis; and</li> <li>positive psychological, pediatric, and neurological assessment as determined by a multidisciplinary team.</li> </ul> Children with severe to profound HL in one ear and typical hearing or mild HL in the contralateral ear are candidates for unilateral CI. Children, six years of age or older, with severe to profound HL in one ear and moderate to severe HL in the contralateral ear are candidates for bimodal stimulation (CI for the worse ear and hearing aid for the better hearing ear).

"Contraindications of the cochlear implant are: congenital malformations with bilateral agenesis of the cochlea, absence of auditory canal function, the presence of diseases leading to central type hearing loss, severe psychiatric diseases, diseases that would contraindicate surgery using general anaesthesia, the absence of motivation towards implantation or noncompliance of audiological criteria. Some patients with these contraindications (cochlear malformations and malformations of the cochlear nerve, total cochlear ossifications of meningitis origin) could be candidates for treatment with auditory brainstem implants" (p. 52).

Adults (18 years or older) with hearing loss may be candidates for cochlear implantation (CI) if they demonstrate the following criteria: <ul> <li>a severe (71-90 dB hearing loss [HL]) to profound (greater than 90 dB HL), bilateral sensorineural hearing loss in conversational frequency range (500-4000 Hz);</li> <li>no or minimum benefit achieved from a hearing aid for either tonal or functional level (less than 40% in voice test to 65 dB SPL) after a 3-6 month trial period (unless contraindicated);</li> <li>confirmation of the presence of the cochlear nerve and the viability of electrode insertion;</li> <li>a diagnosis of meningitis requiring emergency implantation due to risk of ossifying labyrinthitis; and</li> <li>patient's belief that a CI would provide personal and social benefits.</li> </ul> Adults with a comorbid visual impairment or a disease causing bilateral labyrinth obliteration are candidates for bilateral CI. Adults with severe to profound HL in one ear and typical hearing or mild HL in the contralateral ear are candidates for unilateral CI. Adults with with severe to profound HL in one ear and moderate to severe HL in the contralateral ear are candidates for bimodal stimulation (CI for the worse ear and hearing aid for the better hearing ear).