How is the children's implant profile used in the Cochlear Implant Candidacy Process?

The complex process of cochlear implant candidacy assessment at The Children's Hospital of Philadelphia (CHOP) is guided by a modified version of the Children's Implant Profile (ChIP) that has been used world wide over the past 18 years. The aim of this study is to analyze the use of the modified ChIP (mChIP) in the candidacy process by the CHOP Cochlear Implant Program. Of special interest were those cases in which the recommendation regarding implantation appeared inconsistent with the mChIP score. These were further analyzed to understand the real-life decision processes.

This retrospective study involved 121 children assessed for cochlear implant candidacy at CHOP over a 2-year period. The mChIP ratings of No Concern, Some Concern and Great Concern were assigned values of 1, 2 and 3, respectively. Values of 1.5 and 2.5 were used when the check mark was on the boundary between two categories. An average score was calculated and the relationships between mChIP scores and the recommendation regarding implantation were examined.

Eighty-seven children were considered suitable for cochlear implantation; implantation was not recommended for 20. Another 14 cases in which one or more areas of the mChIP had not been completed were excluded. Using a criterion based solely on the mean score would correctly predict 75% of the team's recommendations to implant and 75% of recommendations not to implant. Examination of the cases where implantation was not recommended illuminated the decision-making process.

A statistical analysis of the mChIP fails to capture the complexity of the decision-making process. Most important, it appears that the team's practice is generally to recommend implantation when there is at least a modest prospect of benefit, unless there are absolute contraindications or many areas of Great Concern.