Severe versus profound sensorineural hearing loss in children: implications for cochlear implantation

The advent of cochlear implants for children has stimulated interest in the specific sensory deficits and communicative capabilities of children with severe or profound bilateral sensorineural hearing loss. Appropriate management of these children and their families requires an appreciation of the multifaceted developmental and educational challenges confronting deaf children, even after cochlear implantation. Evaluation results from 200 children with bilateral sensorineural deafness (63 severe/137 profound, anacusic, and fragmentary) reveal significant differences between these two subpopulations. Within the profoundly impaired group, important differences were also noted in the children's ability to benefit from conventional amplification, depending on residual hearing at or above 1000 Hz. Strategies for assessing auditory function and aided benefit in severely and profoundly hearing-impaired children must involve a pediatric test battery, serial evaluations, and parental cooperation/support. When selecting candidates for cochlear implantation, it is inappropriate to categorize severely hearing-impaired children with those children having profound sensorineural losses. Even profoundly impaired populations are not homogeneous, and rehabilitation potential with conventional amplification must be determined on an individual basis, over time.