Potential benefits from cochlear implantation of children with unilateral hearing loss.

ABSTRACT

OBJECTIVES/METHODS: The aim of this discussion paper is to review several issues relevant to the viability of cochlear implantation of children with severe-profound unilateral hearing loss (UHL) and to discuss to what extent published findings on these issues can predict likely benefits from implantation in this population. RESULTS: Several key issues are apparent from the recent literature (i) UHL results in significant educational and psycho-social difficulties, but these are not universal in pre-lingual cases and may not be apparent for several years after birth, (ii) conventional treatments (contralateral routing of signal aids or bone-anchored hearing aids) provide limited benefit in the majority of sensorineural cases, (iii) early published outcomes from implantation of a limited number of children with acquired UHL suggest benefits similar to those observed in postlingually deafened adults, (iv) unilateral auditory deprivation results in poorer outcomes from delayed implantation of children with congenital losses, and (v) a large proportion of cases of severe-profound sensorineural UHL are associated with structural abnormalities of the cochlea or VIII nerve, such that not all children with UHL may be suitable for cochlear implantation. CONCLUSIONS: Children with acquired UHL are likely to gain similar positive benefits from cochlear implantation as those recently reported in adults (improved localization and better speech understanding in specific noise conditions). However, implantation of children with prelingual UHL is currently problematic as the impact of UHL may not become apparent until the child enters full-time education, by which time outcomes from cochlear implantation may be sub-optimal due to auditory deprivation. Development of appropriate candidacy criteria is important but challenging as criteria may need to be based on real-world hearing difficulties as well as audiological measures.