Evaluating (inter)national variations of cochlear implantation in children: Towards evidence-based practice uniformity for cochlear implantation in children

Abstract

Substantial evidence shows that cochlear implantation is the preferred treatment for infants presenting with severe to profound hearing loss. However, the sensitive period of neurolinguistic development varies between speech and language domains, and therefore, determining the ideal timing for cochlear implantation based on these time frames remains difficult and has not yet been strictly defined. Furthermore, differences between cochlear implant manufacturers’ and national cochlear implant guidelines exist regarding paediatric cochlear implant candidacy eligibility criteria. Since no uniform indication criteria currently exist, this dissertation formulates an evidence-based guideline for cochlear implantation in children. Definition of uniform indication criteria and a structured timeline of the selection process of pediatric cochlear implant cadidates can help parents understand both clinical processes and thus prevent delay in care. Through three literature studies and four retrospective studies, data were gathered to formulate evidence-based guidelines. Based on our findings, we recommend that children with prelingual hearing loss, without serious co-morbidity, undergo cochlear implantation if: 1. They are between 12 and 18 months old, based on four speech and language domains (speech perception and production, receptive language development and auditory performance) 2. They present with hearing loss of ≥ 80 decibels (2-frequency Pure Tone Average thresholds of ≥ 85 decibels of hearing loss or 4-frequency Pure Tone Average thresholds of ≥ 80 decibels of hearing loss) 3. The mastoidectomy with posterior tympanotomy technique is used peroperatively. In terms of anesthetic technique, both intravenous propofol and sevoflurane (inhalation) gas can be used. In our international assessment, we found that only 30% of the European pediatric population was implanted before the age of 24 months. This delay in care provision is remarkable and can be shortened in the future by: more optimal compliance with already implemented guidelines, improved alignment between international guidelines and more awareness among parents of the impact of hearing loss for their child. Through our evidence-based advice we hope to reduce variation from clinician to clinician. In the future, we expect that by providing information via telemedicine (e.g., the application of mobile applications), parents better understand the indication criteria and the timeline of the candidate selection and delay in auditory rehabilitation can be prevented.