Who can benefit from a cochlear implant?

Children and adults who have developed hearing loss on account of meningitis, should be referred and assessed for potential cochlear implantation as a matter of urgency.

Children and adults who cannot attain useful benefit from conventional hearing aids may benefit from a cochlear implant. The Pretoria Cochlear Implant Unit provides assistance to babies, children, adults, and the elderly who were born with, or later developed, hearing loss.

Click on the sections below to look at the candidacy guidelines for children and adults.


The Pretoria Cochlear Implant Unit considers children of all ages (from babies to children up to the age of 18) for possible cochlear implantation. Once a child is enrolled with us, each patient undergoes a multidisciplinary assessment and the following guidelines are used to determine candidacy for each individual child:

Age:

  • No minimum age
  • Children with congenital or prelingual deafness in general seem to progress more rapidly and benefit more when they are younger at implantation.
  • Children over the age of 3 years presenting with congenital or prelingual deafness, should present with objective proof of developing oral language skills.
  • Children over the age of 4 years with no oral language skills will only be considered on an individual case basis.
  • Children over the age of 5 with no oral language are unlikely to benefit from cochlear implantation.
  • Children with post-lingual deafness (developed after the age of 5 years), can benefit from cochlear implantation if they are implanted soon after the onset of the profound hearing loss.

Audiological criteria:

  • Candidates will typically present with bilateral severe to profound sensorineural hearing loss i.e. greater than 85dBHL at 2 and 4kHz. In exceptional circumstances, for instances of certain causes of deafness, individuals with better hearing levels may be considered.
  • Candidates should go through a minimum of a 3 month optimised hearing aid trial. In exceptional cases, such as those deafened by meningitis and certain other circumstances, this requirement may be waived. Referrals are accepted prior to this hearing aid trial.
  • Limited benefit from continuous use of optimally fitted hearing aids regardless of consistent auditory training and rehabilitation.
  • Children with Auditory Neuropathy Spectrum Disorder and fitted with suitable hearing aids but are presenting with slow progress in speech and language development.
  • A child’s speech and language level will have to be assessed in detail.

Additional guidelines and criteria:

Education:

  • The child must have access to an educational program that supports listening and speaking for communication.
  • Access to a therapy program with a strong emphasis on auditory training is of great importance.
  • Candidates will typically fail to develop, improve or maintain speech, language, communication and listening skills appropriate to their age, development and cognitive ability.
  • Children with additional disabilities will also be considered – on an individual basis.

Medical:

Medical and surgical contra-indications will be determined by the Ear-, Nose- & Throat specialist. An MRI and CT scan will have to be performed to determine the presence of any contra-indications and can include:

  • Abnormal or absent cochlea/e
  • Lesions or abnormalities of the hearing nerve/s or central auditory pathway/s.
  • Cochlear ossification that can influence the placing of the electrode array

Psycho-social:

  • Parents and family must be highly motivated and committed to extensive pre- and post-implantation assessments and long-term therapy and rehabilitation.
  • Realistic expectations of potential outcomes must be present.
  • Older children should understand the process and give their consent to the procedure.

Adults aged 19 years and above (no maximum age) are considered for cochlear implantation. Each person undergoes careful multidisciplinary assessment. The guidelines and criteria which are considered include:

Audiological criteria:

  • Candidates with severe to profound hearing loss in both ears are considered. Typically candidates will have, a severe to profound sensorineural hearing loss i.e. greater than 85dBHL at 2 and 4kHz in the better hearing ear. In exceptional circumstances, for instances of certain causes of deafness, individuals with better hearing levels may be considered.
  • Candidates typically have inadequate benefit from consistent optimized hearing aid use.
  • New indications for cochlear implantation include ski-slope hearing loss, reverse slope hearing loss, asymmetric hearing loss and single sided deafness.
  • Where necessary, candidates should go through a minimum of a 3 month optimised hearing aid trial.
  • Chronological age and duration of deafness: We consider adults of all ages, with all issues relating to duration of deafness considered on an individual basis.
  • Adults with additional needs will also be considered.

Additional guidelines and criteria:

Medical

Medical and surgical contra-indications will be determined by the Ear-, Nose- & Throat specialist. An MRI and CT scan will have to be performed to determine the presence of any contra-indications and can include:

  • Abnormal or absent cochlea/e
  • Lesions or abnormalities of the hearing nerve/s or central auditory pathway/s.
  • Cochlear ossification that can influence the placing of the electrode array

Psycho-social:

  • Patient and family must be highly motivated and committed to extensive pre- and post-implantation assessments and long-term therapy and rehabilitation.
  • Patient should be motivated to be part of the hearing world.
  • Realistic expectations of potential outcomes must be present.
  • Older children should understand the process and give their consent to the procedure.

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Contact Details

Pretoria Cochlear Implant Unit
University of Pretoria (Main Campus)
c/o Lynnwood Road and Roper Street
Communication Pathology Building, Room 3-32
Hatfield
Pretoria

Tel Office: 012 420 3684
Email Office: ptacoch@up.ac.za