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Pre-Implant for Candidates

Who is a Candidate for the Cochlear Implant?

Cochlear implants are recommended when a person cannot obtain sufficient hearing from hearing aids to rely on listening for communication. Years of research and clinical experience have contributed to the development of guidelines for determining when a cochlear implant should be recommended. The Food and Drug Administration (FDA) approves the use of cochlear implants for individuals who meet the specified criteria. Insurance companies often follow these guidelines when determining if the cochlear implant is a covered expense.

General Criteria

Adults as well as children (at least 12 months of age)
Severe-to-profound hearing loss
Individuals who are healthy enough to undergo the cochlear implant surgery
Candidates whose families are motivated to use listening for communication

Younger children

Lack of benefit from appropriately fit hearing aids that are worn consistently on a full time basis
Lack of progress or a plateau in auditory development
Older children and adults: on standardized tests in the best aided condition
30% or less word identification for children
40-60% or less on sentence identification for adults

How is Cochlear Implant Candidacy Determined?

Before receiving a cochlear implant, evaluations are performed that include medical, audiologic, and communication testing. This helps to determine if the individual is a good candidate for implantation.

With children, a trial period with hearing aids and auditory-verbal or aural rehabilitation therapy is part of the candidacy process. This ensures that we can assess the child in the best aided condition and determine candidacy as well as educate the family on the steps needed to enhance speech and language acquisition.

Candicacy Evaluation

Evaluation Prerequisites:

Do you have HEARING
AIDS?
If not, you will need a HEARING AID EVALUATION and FITTING from the USC Speech & Hearing Research Center.

Medical Exam including Imaging Studies

To determine medical candidacy for a cochlear implant
To investigate cause of hearing loss (genetic testing, MRI or CT scan)
To discuss the surgical aspects and risks involved in surgery

Cochlear Implant Consultation

To get to know the candidate and family and obtain a complete history
To provide information to the candidate and family about hearing loss and cochlear implants
To address questions and concerns and discuss appropriate expectations and goals for hearing, speech, and language

Audiological Evaluation

To determine hearing status with and without hearing aids
To determine ability to understand speech with hearing aids

Speech/Language
Evaluation (Child)

To document communication abili-ties
To provide information on speech and language development
To acquire information about the child’s current educational situation and offer support as needed

Speech/Language Trial Therapy (Child)

To provide information on auditory-verbal or aural rehabilitation therapy
To model auditory acquisition techniques for the parents and family of the child

Candidate Profile

This is a summary of factors that effect outcome with a cochlear implant and includes the information obtained from the candidate and family. It helps identify areas that can be impacted by change and helps families develop realistic expectations for the recipient’s use of an implant. It’s not intended to be a grade, but a tool to open communication about how the team can increase chances of achieving spoken language perception and use. The items we review are as follows:

TEAM IMPRESSIONS OF FACTORS IMPORTANT TO IMPLANT USE AND SUCCESS	No Concern	Mild-Moderate Concern	Great Concern
CHRONOLOGICAL AGE / DURATION OF DEAFNESS	< 2 years	2 years to 4 years	> 4 years
MEDICAL/RADIOLOGICAL Non-Otological Otological	Good general health	Health concerns that require attention & time but do not affect rehab process or device use i.e.: cardiac issues, occasional seizure or active airway disorders	Considerable health concerns that affect child’s attention, ability to speak, or consistently use device, i.e. airway disorder or frequent seizures
MEDICAL/RADIOLOGICAL Non-Otological Otological	Cochleae are normal and patent	Minor malformation (EVA, Mondini), extensive middle ear disease, craniofacial abnormalities	Major malformation (common cavity, hypoplastic cochlea, absent semicircular canals)
ASSOCIATED DISORDERS	No disabilities other than deafness	Blindness, oral motor disorder, sensory integration issues, learning disabilities	Global developmental delay, 2 or more mild/moderate handicapping conditions
AUDIOLOGY Test Reliability Hearing Aid Use Hearing Aid Benefit Use of Residual Hearing	Good test reliability	Fair test reliability	Poor test reliability
	History of consistent hearing aid use.	Limited hearing aid use (> 50%)	No history of consistent use
	Little or no hearing aid benefit	Some hearing aid benefit	Excellent hearing aid benefit
	Maximizing current auditory potential	Limited progress with residual hearing	No benefit from residual hearing
SPEECH PATHOLOGY Formal Language System Use of Voice/ Oral Motor Desire to Communicate	Formal language system in place: appropriate nonverbal communicative intent	Formal language system emerging; delays in primary communication	No formal language system in place
	Consistently uses voice/ appropriate oral motor development	Requires occasional cues to voice/ mild oral motor delays	Absent use of voice / significant oral motor delays
	Age appropriate attempts to communicate	Moderate intervention to engage child in appropriate communication	Maximum therapist intervention needed to elicit appropriate attention/ communication from child
FAMILY SUPPORT Family Structure/Support Parents Participation in Educational Process	Family communicates effectively / effectively coping with stress	Some family members communicate effectively; moderate stress/ occasional missed appointment	Family does not communicate effectively /severe stress/ past history of noncompliance
	Parents actively engaged in child’s therapy/educational program; able to understand educational system/ (IEP/IFSP); strong advocacy skills	Parents demonstrate some involvement in therapy; beginning knowledge of educational system; potential advocacy skills	Parents do not participate in therapy; little understanding of educational system; appears to have poor advocacy skills
EXPECTATIONS Parent/Significant Others Candidate	Realizes CI will not restore normal hearing; family agreement about implant; family has a plan for rehab	Believe child will move to a mainstream setting with no support services; expectations are inflexible; family has no plan for rehab	Believe CI will restore normal hearing/ solve any other medical issues
EXPECTATIONS Parent/Significant Others Candidate	Realizes CI not corrective & will need therapy	Believes will not need help using CI	Believes CI will restore normal hearing
INTERPERSONAL SKILLS/INTERNAL MOTIVATION	Behavior typical for age; effective parental control of behavior; child demonstrates desire to learn Candidate shows appropriate interpersonal skills all the time and wants to communicate better and will do whatever is necessary	Inconsistent engagement in therapy sessions; sporadic parental control of child's behavior; some desire to learn Candidate shows appropriate interpersonal skills most of the time and wants to communicate better and will do the minimum work to achieve communication	Severely hyperactive; aggressive or defiant behavior; poor parental control of child's behavior; Consistent disengagement in therapy sessions Candidate shows inappropriate interpersonal skills and does not want to work to communicate better
EDUCATION (MS = mainstream, Tx = therapy, Ed = education) Current Educational Placement Future Educational Placement Availability of Support Services Staff CI Training	Auditory oral class or oral MS; appropriate Ed. environment	TC; special ed	ASL; self-contained class; no auditory tx
	Auditory oral class or oral Ms; appropriate Ed environment	Limited auditory based intervention; special ed	ASL/ TC self contained class; no auditory tx
	Program provides appropriate auditory based intervention	Program will provide moderate levels of auditory based intervention	Program will provide minimal amounts of auditory based intervention
	Teachers and therapists with training and experience in the development of spoken language through listening and CI	Teachers and therapists with beginning training and experience in the development of spoken language through listening and CI	Teachers and therapists with no training or experience in the development of spoken language through listening and CI

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