Criteria versus guidelines: Are we doing the best for our paediatric patients?

The National Institute for Health and Care Excellence guidance for the provision of cochlear implants (NICE Technology Appraisal Guidance 166. Cochlear implants for children and adults with severe to profound deafness. 2009. National Health Service National Institute for Health and Clinical Excellence.) are used to develop candidacy criteria by public health funding bodies within the UK. Often the guidance is interpreted as strict 'criteria' whereby clinicians adhere to specific audiometric thresholds without accounting for the acceptable range of performance on individual tests or a child's functional development. In this paper four clinical paediatric case studies are described from two cochlear implant centres which serve to illustrate difficulties in applying NICE guidance as strict criteria. These are presented in the context of recommending more flexible interpretation based on the content of the current guidance along with considerations of circumstances where NICE guidance might be adapted to optimise use of cochlear implant technology within a national framework.

Cochlear implant assessment and candidacy for children with partial hearing.

Children who have partial hearing (PH) in the low frequencies and profound sensorineural hearing loss in the high frequencies can present a challenge to cochlear implant (CI) teams in terms of referral, assessment, and candidacy. Neither clinical criteria nor optimal timing for implantation has been explored in the literature. Data from both the Hearing Implant Centres of Birmingham Children's Hospital and St Thomas' Hospital indicate that it is clinically appropriate to implant children with PH; they perform better with CIs than with hearing aids, even if their hearing is not fully preserved. We have also found that children need early access to high frequency sound in order to reach their full potential.