Pediatric cochlear implantation: A quarter century in review

Abstract

Objective: To review the growth of a pediatric cochlear implant (CI) program at one large tertiary care medical center over a 25-year period in order to (1) describe the population of pediatric cochlear implant recipients, (2) document word recognition outcomes, and (3) describe changes in candidacy criteria over time.

Design: A retrospective review of population demographics and trends included etiology of hearing loss, device use and type, expansion of inclusion criteria, and word recognition outcomes.

Results: Ninety-one percent of the children studied were from North Carolina and reflect the ethnic distribution of the state. The population is heterogeneous for etiology and the presence of syndromes and/or co-morbidities. A trend of lower age of implant and greater residual hearing was documented overtime. As a single metric, monosyllable word recognition for the children assessed is good with the mean CNC test word score of 76.13% (range 0–100, S.D = 19.94).

Conclusions: Pediatric cochlear implant candidacy criteria have evolved despite no change in FDA-approved regulations since 2000. There is great diversity among recipients but word recognition outcomes are generally good in this population and have improved over time. Professionals who may refer children for cochlear implantation should be aware of current clinical practices and general outcomes.

Keywords:

• Pediatric cochlear implants
• Candidacy expansion
• Word recognition outcomes

Acknowledgements

We would like to thank the Broyhill Family Foundation for providing color figures in this work. We gratefully thank children and families for enabling this study. We also acknowledge the pediatric audiology team at UNC, led by Dr. Patricia Roush, for providing excellent patient management of children prior to implantation. Members of the UNC cochlear implant team, current and past, who contributed to this study, in addition to the authors are as follows:

Audiologists – Melissa Auchter, Carolyn Brown, Dave Catlett, Erika Gagnon, Aimee Gross, Deborah Gunter, Debora Hatch, Debby McDowall, Tara Sherrill, Amanda Shipp Smith, Christie Kruger, Nancy McIntosh, Jennifer Woodard

Speech-Language Pathologists – Sabrina Aguilar-Simon, Hannah Eskridge, Maegan Evans, Sandra Hancock, Lillian Henderson, Christine Kramer, Thomas Page, Erin Thompson, Kathryn Wilson

Teachers of the Deaf – Francisca Hernandez, Sindy Sebrell, Sherri Vernelson, Beth Whitfield

Surgeons- Oliver Adunka, Craig Buchman, Vincent Carrasco, Lauren Kilpatrick, Brendan O’Connell, Carol Shores

Disclaimer statements

Contributors None.

Funding This work was supported by the Broyhill Family Foundation.

Conflicts of interest None.

Ethics approval None.

Notes on contributors

Holly F.B. Teagle, AuD is an Associate Professor in Audiology at the University of Auckland and the Clinical Director at The Hearing House in Auckland, New Zealand. Research interests include cochlear implant outcomes and clinical management issues. She has authored over 50 peer-reviewed articles and 13 academic textbook chapters.

Lisa R. Park, AuD is an Assistant Professor at the University of North Carolina in Chapel Hill. Her research focuses on expanding indications for cochlear implantation in children.

Kevin D. Brown, MD, PhD is Vice Chair and Associate Professor of Otolaryngology at the University of North Carolina School of Medicine. He is also Medical Director of the Children's Cochlear Implant Center at UNC.

Carlton Zdanski, MD is an Associate Professor and Chief of Pediatric Otolaryngology at the University of North Carolina at Chapel Hill. He has been a member of the pediatric cochlear implant surgical team since 2002.

Harold C. Pillsbury, MD is Emeritus Chair of the Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina at Chapel Hill, and Executive Director of the Children's Cochlear Implant Center at UNC. He collaborates on clinical research projects investigating outcomes of expanded indications for cochlear implantation.

ORCID

Holly F.B. Teagle http://orcid.org/0000-0002-6907-5284

Lisa R. Park http://orcid.org/0000-0001-9804-2425