Considerations for cochlear implantation of children with sudden, fluctuating hearing loss

The histories of two pediatric patients who received cochlear implants with subsequent partial recovery of hearing in the nonimplanted ear are reviewed. One child had a sudden bilateral hearing loss, presumably secondary to autoimmune ear disease. The other child had a bilateral progressive hearing loss diagnosed as large vestibular aqueduct syndrome (LVAS). The rationale for the timing of the surgical implantation is discussed. Retrospectively, recovery of hearing in the nonimplanted ear suggests the possibility that the implant could have been delayed or eliminated as a treatment option, and that wearable hearing aids may have been appropriate. A number of factors, however, suggest the decision to implant was appropriate. Issues involved in the decision-making process of when to implant are presented and discussed.