When to Recommend Cochlear Implants vs Hearing Aids?
Lovett, Vickers, and Summerfield addressed the delineation point at which a child is four times more likely to excel with cochlear implants (CIs) as compared to hearing aids. Of note, CI outcomes for an individual cannot be predicted ahead of time as the variation in outcomes (among individuals) is huge (Davidson, 2011). Nonetheless, we can make statistical predictions for the population.
After evaluating 71 children (mean age 64 months, 28 with bilateral CIs, 43 with bilateral hearing aids) in the United Kingdom, they determined (in accordance with Boothroyd, 1993) that to achieve a likelihood of a 4:1 chance of a better outcome with CIs, a mean 4FPTA of 80 dB HL is the general delineation. Of note, in the United States (2015), the FDA approves CIs for children ages 12 to 23 months given a 3FPTA of 90 dB or greater.
Meister et al (2015) reported on the “real-world communication performance of children provided with cochlear implants (CIs),” as compared to matched peers with hearing aids (HAs). Further, they evaluated and considered “hearing age” of each child in their weighting (less than 12 months, 12 to 23 months, 24 to 35 months, 36 to 47 months, and 48 months and greater) as speech and language ability (for children with hearing loss) “…show the greatest changes within the first 4 years of device usage….” In brief, they found that children with mild hearing losses and hearing aids outperformed two other groups; children with moderate-to-severe hearing losses and hearing aids, and children using cochlear implants. However, there were no statistically significant changes in the two groups; children with moderate-to-severe hearing losses and hearing aids, and children using cochlear implants.
For More Information, References, and Recommendations
Boothroyd A. (1993) Profound Deafness. In R. Tyler (Ed). Cochlear Implants—Audiological Foundations (pages 1-33). London: Whurr.
Davidson LS, Geers AE, Blamey PJ. (2011) Factors contributing to Speech Perception Scores in Long-Term Cochlear Implant Users. Ear & Hearing 32 (Suppl 1):19S-26S.
Lovett RES, Vickers AD, Summerfield AQ (2015) Bilateral Cochlear Implantation for Hearing Impaired Children—Criterion od Candidacy Derived from an Observational Study. Ear & Hearing 36(1):14-23
Meister H, Keilmann A, Leonhard K, Streicher B, Muller L, Lang-Roth R. (2015) Real-World Verbal Communication Performance of Children Provided with Cochlear Implants or Hearing Aids. Otology & Neurotology 36:1023-1028.