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Updated: Jun 21, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Parental and program's decision making in paediatric simultaneous bilateral cochlear implantation: who says no and
James D Ramsden1, Vicky Papaioannou, Karen A Gordon
1Cochlear Implant Program, The Department of Otolaryngology, The Hospital for Sick Children, Toronto, Canada. james.ramsden@orh.nhs.uk
Insights
Not all children are candidates for simultaneous bilateral cochlear implantation. Suitability depends on developmental status, hearing in the second ear, anatomy, and parental consent, with some progressing to sequential implantation.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neurosurgery
Background:
- Bilateral cochlear implantation is often considered optimal for auditory outcomes.
- Assessing candidacy for simultaneous bilateral cochlear implantation in children is crucial.
Purpose of the Study:
- To evaluate initial candidacy for bilateral simultaneous cochlear implantation in pediatric patients.
- To identify factors influencing suitability for simultaneous bilateral cochlear implantation.
Main Methods:
- Prospective case series conducted at a tertiary academic pediatric hospital.
- 46 children eligible for cochlear implantation were assessed for simultaneous bilateral implantation suitability.
- Data collected over a 12-month period (January-December 2007).
Main Results:
- 17 children (37%) received simultaneous bilateral implants.
- 29 children (63%) were unsuitable due to developmental delay, residual hearing, parental refusal, speech development, or cochlear anatomy.
- No patients were deemed medically unsuitable for the procedure.
Conclusions:
- Simultaneous bilateral cochlear implantation suitability varies among pediatric candidates.
- Factors beyond medical necessity influence the decision for simultaneous bilateral implantation.
- Some children not suitable for simultaneous implantation may be candidates for sequential bilateral implantation.
Objective:
To evaluate initial candidacy for bilateral simultaneous cochlear implantation in children.
Design:
Prospective case series.
Setting:
Tertiary academic pediatric hospital.
Participants:
As part of our research protocol all children eligible for cochlear implantation were assessed for suitability to receive a simultaneous bilateral implant. Over a 12-month period (January to December 2007) 78 children received a total of 95 cochlear implants. Children with sequential second implants (24), revision cases (4), and out of province recipients (4) were excluded. The remaining 46 patients were assessed for bilateral simultaneous implantation.
Main Outcome Measures:
Team/parental decision to proceed with bilateral simultaneous implantation.
Results:
17 children (37%) received simultaneous bilateral implants. 29 children (63%) were not considered suitable for simultaneous bilateral implantation. Reasons included developmental delay (10), residual borderline hearing in the second ear (9), parental/patient refusal (6), abnormally poor speech development for age (2), and abnormal cochlear anatomy precluding implantation (2). None were considered unsuitable for the more prolonged operative procedure on medical grounds.
Conclusions:
Although bilateral implantation is thought to produce the optimal auditory outcome, not all patients are suitable, nor do all parents wish to proceed, when assessed for simultaneous implantation. Some of these patients are likely to be candidates for sequential bilateral implantation in due course.