Cochlear Implantation for Children and Adults With Severe to Profound Deafness
National Institute for Health and Care Excellence. (2019).
London (United Kingdom): National Institute for Health and Care Excellence, 1-30.
This guideline updates the National Institute for Health and Care Excellence's 2009 <em>Cochlear Implants for Severe to Profound Deafness in Children and Adults</em> document. The current guideline provides recommendations regarding cochlear implantation in children and adults with severe to profound deafness.
National Institute for Health and Care Excellence (United Kingdom)
"Sequential bilateral cochlear implantation is not recommended as an option for people with severe to profound deafness," (p. 4) "defined as hearing only sounds that are louder than 80 dB HL (pure-tone audiometric threshold equal to or greater than 80 dB HL) at 2 or more frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz and 4,000 Hz) bilaterally without acoustic hearing aids" (p. 5).
When assessing individuals for cochlear implant candidacy, audiological tests should accommodate the individual's disabilities or communication difficulties, and other methods of assessment should be considered if the individual is not sufficiently fluent in the language of the testing materials available.
"If different cochlear implant systems are considered to be equally appropriate, the least costly should be used. Assessment of cost should take into account acquisition costs, long-term reliability and the support package offered" (p. 4).
Simultaneous bilateral cochlear implantation is recommended for adults
<ul>
<li>with blindness or other disabilities that require a "reliance on auditory stimuli as a primary sensory mechanism for spatial awareness" (p. 4); and</li>
<li>"with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids" (p. 4). </li>
</ul>
This updated guideline defines severe to profound deafness as "a phoneme score of 50% or greater on the Arthur Boothroyd word test presented at 70 dBA" (p. 5).
"Cochlear implantation should be considered for children and adults only after an assessment by a multidisciplinary team. As part of the assessment children and adults should also have had a valid trial of an acoustic hearing aid for at least 3 months (unless contraindicated or inappropriate)" (p. 5).
Children with severe to profound deafness who do not receive adequate benefit from hearing aids should have the option to undergo unilateral or simultaneous bilateral cochlear implantation; sequential bilateral cochlear implantation is not recommended.<br />"Unilateral [or simultaneous bilateral] cochlear implantation is recommended as an option for children with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids, as defined [by].... speech, language and listening skills appropriate to age, developmental stage and cognitive ability" (pp. 4-5).
