Abstract
More children with complex needs are being referred for cochlear implant assessment. Part of the assessment to determine whether the child is suitable for a cochlear implant and when tuning the implant itself is to try to obtain accurate threshold responses to acoustic or electrical stimuli. The behavioural and objective tests of hearing used to do this are outlined along with some of the issues when performing these tests on children with complex needs. Just because a child has complex needs as well as deafness should not mean they are ruled out for consideration for cochlear implantation. However there are issues which need to be addressed with the family prior to a decision. There is a lack of pre-operative candidature criteria and post-operative outcome measures specific for children with complex needs. A greater evidence base is needed to allow informed decisions to be made.