Cochlear Implantation in Nontraditional Candidates

OBJECTIVE: Traditionally, children are cochlear implant (CI) candidates if bilateral severe to profound hearing loss is present and amplification benefit is limited. The current study investigated abilities of adolescents with asymmetric hearing loss (one ear with severe to profound hearing loss and better hearing contralaterally), where the poorer ear received a CI and the better ear maintained amplification. STUDY DESIGN: Within-subject case study. SETTING: Pediatric hospital, outpatient clinic. PATIENTS: Participants were 5 adolescents who had not met traditional CI candidacy because of one better hearing ear but did have 1 ear that met criteria and was implanted. All maintained hearing aid (HA) use in the contralateral ear. In the poorer ear, before implant, 3 participants had used amplification, and the other 2 had no HA experience. MAIN OUTCOME MEASURE: Participants were assessed in 3 listening conditions: HA alone, CI alone, and both devices together (bimodal) for speech recognition in quiet and noise and sound localization. RESULTS: Three participants had CI open-set speech recognition and significant bimodal improvement for speech recognition and localization compared with the HA or CI alone. Two participants had no CI speech recognition and limited bimodal improvement. CONCLUSION: Some adolescents with asymmetric hearing loss who are not typical CI candidates can benefit from a CI in the poorer ear, compared with a HA in the better ear alone. Additional study is needed to determine outcomes for this population, especially those who have early onset profound hearing loss in one ear and limited HA experience.