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Position Statement: Pediatric Cochlear Implantation Candidacy

Position Statement: Pediatric Cochlear Implantation Candidacy

There is ample evidence that early cochlear implantation of children with sensorineural hearing loss (SNHL) for whom hearing aids provide inadequate access to sound is advantageous. Early implantation improves auditory and language outcome (1-8) and may be done safely. (9-13)

Children with bilateral severe to profound SNHL (4-frequency PTA > 80 dB HL or 2-frequency PTA > 85) will not receive adequate benefit from amplification and are candidates for bilateral cochlear implantation. (2) Children with this degree of SNHL, including infants between 6 and 12 months, should receive cochlear implants as soon as practicable. Implantation below 12 months of age is correlated with better language outcome. (3,4) Therefore, implantation should not be delayed by a hearing aid trial of an arbitrary prescribed length unsupported by current evidence. Infants below 12 months of age should have objective measures (auditory brainstem response/auditory steady state response testing) of SNHL with confirmatory audiometric results, when possible, prior to implantation.

Children aged 12 months and older with a PTA between 65 and 85dB HL whose early aided auditory skill development and speech and language progress indicate a persistent, or widening, gap in age appropriate auditory and language skills are also eligible for implantation. (1) The Pediatric Minimum Speech Test Battery is critical for providers working with this population to assess their functional benefit from amplification. (14)

For children to obtain the benefit of early implantation, referral of potentially eligible infants and children for candidacy evaluation should be a priority for professionals involved in diagnosis, audiological and medical management, and habilitation of childhood hearing loss. Pre- and post-cochlear implant auditory and spoken language habilitation therapy are essential services for this special population.

Adopted 4/15/2020


  1. Leigh JR, Dettman SJ, Dowell RC. Evidence-based guidelines for recommending cochlear implantation for young children: Audiological criteria and optimizing age at implantation. Int J Audiol. 2016; 55 Suppl 2:S9-S18.
  2. Lovett RE, Vickers DA, Summerfield AQ. Bilateral cochlear implantation for hearing-impaired children: criterion of candidacy derived from an observational study. Ear Hear. 2015 Jan; 36(1):14-23.
  3. Ching, T.Y., Dillon, H., Leigh, G., Cupples, L. (2018).Learning from the longitudinal outcomes of children with hearing impairment (LOCHI)study: summary of 5-year findings and implications. International Journal of Audiology, 57(2): S105-S111.
  4. Dettman SJ, Dowell RC, Choo D, et al. Long-term communication outcomes for children receiving cochlear implants younger than 12 months: a multicenter study. Otol Neurotol 2016;37:e82–95.
  5. Nicholas J and Geers. A spoken language benefits of extending cochlear implant candidacy below 12 months of age Otolo Neurotol 2013; 34: 532-538.
  6. Semenov YR, Yeh ST, Seshamani M, Wang N, Tobey E, Eisenberg L, Quittner, A, Frick, K Niparko, J CDaCI investigative Team. Age-dependent cost-utility of pediatric cochlear implantation. Ear Hear. 2013; 34(4): 402-412.
  7. Lin FR, Wang NY, Fink NE, et al. Assessing the use of speech and language measures in relation to parental perceptions of development after early cochlear implantation. Otol Neurotol. 2008; 29(2):208–213.
  8. Blamey PJ, Sarant JZ, Paatsch LE, Barry JG, Bow CP, Wales RJ, Wright M, Psarros C, Rattigan K, Tooher R. Relationships among speech perception, production, language, hearing loss, and age in children with impaired hearing. J Speech Lang Hear Res. 2001 Apr; 44(2):264-85.
  9. Hoff S, Ryan M, Thomas D, Tournis E, Kenny H, Hajduk J, Young NM. Safety and effectiveness of cochlear implantation of young children, including those with complicating conditions. Otology & Neurotology, April 2019; 40:454-463.
  10. Valencia DM, Rimell FL, Friedman BJ, Oblander MR, Helmbrecht J. Cochlear implantation in infants less than 12 months of age. Int J Pediatr Otorhinolaryngol. 2008 Jun; 72(6):7612.
  11. Cosetti M, Roland JT Jr. Cochlear implantation in the very young child: issues unique to the under-1 population. Trends Amplif. 2010 Mar; 14(1):46-57.
  12. James AL, Papsin BC. Cochlear implant surgery at 12 months of age or younger. Laryngoscope. 2004 Dec; 114(12):2191-5.
  13. Roland J. T., Jr., Cosetti M., Wang K. H., Immerman S., Waltzman S. B. (2009). Cochlear implantation in the very young child: Long-term safety and efficacy. Laryngoscope, 119, 2205–221.
  14. Uhler, K., Warner-Czyz, A., Gifford, R. Archer, M., Austin, K., Barry, M.M., … Zwolan, T. (2017). Pediatric minimum speech test battery. Journal of the American Academy of Audiology, 28, 232-247.

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.

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