Guidelines (Short Version) of the French Society of Otorhinolaryngology (SFORL) on Pediatric Cochlear Implant Indications
European Annals of Otorhinolaryngology, Head and Neck Diseases
Simon, F., Roman, S., et al. (2019).
European Annals of Otorhinolaryngology, Head and Neck Diseases, 136(5), 385-391.
This guideline from the French Society of ENT, or Société Francaise d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL), provides good practice recommendations on cochlear implantation in children.
Société Francaise d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL; France)
This document is an official English translation of a guideline written originally in French. The original French guideline contains recommendations for cochlear implantation in both adult and pediatric populations, while the English translation was split into two separate documents: one for adults and one for children. This document addresses the pediatric population. See the Associated Article section below to find the document for the adult population.
For children undergoing cochlear implantation (CI), "vestibular assessment is recommended ahead of each CI" (Grade C Recommendation; p. 387).
Timing recommendations for children receiving cochlear implantation (CI) are as follows:
<ul>
<li>"In congenital bilateral profound hearing loss, CI should be proposed before 12 months of age" (Grade B Recommendation; p. 386).</li>
<li>"In sequential bilateral cochlear implantation for severe to profound hearing loss, the interval between implantations should be short (Grade B Recommendation; p. 387), preferably less than 18 months" (Expert Opinion; p. 387). "It is recommended to keep the interval as short as possible if a contralateral hearing aid fails to provide benefit (Grade B Recommendation; p. 387).</li>
</ul>
For children who undergo cochlear implantation, "rehabilitation should combine acoustic and electrical stimulation in case of low-frequency residual hearing" (Grade B Recommendation; p. 388).
Assessment recommendations for children receiving cochlear implantation (CI) are as follows:
<ul>
<li>"In case of residual hearing, tests in noise should be included in the pre-CI work-up as soon as feasible" (Grade C Recommendation; p. 387). </li>
<li>"In case of CI with contralateral hearing aid, perception should be assessed as early as possible, with speech-in-noise and acoustic location tests, and hearing aid efficacy should be regularly reassessed" (Grade B Recommendation; p. 387). </li>
<li>"In very young children with unilateral CI and useful residual hearing, caution is recommended in indicating a second CI, as binaural function is difficult to assess" (Expert Opinion; p 387).</li>
<li>"It is recommended to assess the resources, difficulties and needs of the family environment ... and to encourage the child to be involved in the management of hearing loss and rehabilitation and to accompany him or her in this" (Grade B Recommendation; p.387).</li>
<li>"It is recommended to assess pre- and post-CI quality of life alongside audiometry" (Grade A Recommendation; p. 388). </li>
<li>"Several versions of a given quality of life instrument should be available, adapted to age" (Expert Opinion; p. 388).</li>
</ul>
Recommendations for children with unilateral hearing loss receiving cochlear implantation (CI) are as follows:
<ul>
<li>"Children with unilateral CI should be encouraged to use a contralateral hearing aid in case of residual hearing" (Grade B Recommendation; p. 388).</li>
<li>"It is recommended that studies should assess the benefit of CI in children with acquired or congenital severe to profound unilateral sensorineural hearing loss" (Expert Opinion; p. 388).</li>
</ul>
"Bilateral cochlear implantation is recommended for children with bilateral severe to profound hearing loss" (Grade B Recommendation; p. 386).
Counseling and education recommendations for children receiving cochlear implantation (CI) are as follows:
<ul>
<li>"Parents of children with pathologies associated with hearing loss (multi-disability) should be informed that CI results may be limited; they should consider their expectations in dialogue with a multidisciplinary team" (Grade B Recommendation, p. 388).</li>
<li>"It is recommended that the parents be informed of the risk of immediate postoperative and long-term loss of residual hearing following CI" (Grade C Recommendation; p. 388).</li>
</ul>
For children with hearing loss, "pedopsychiatric assessment and brain MRI are recommended for children who are candidates for [cochlear implantation] CI, or following CI in case of signs suggestive of autism" (Grade B Recommendation; p. 387).
