Cochlear Implantation in Children Without a Hearing Aid Trial: A Case Series of 22 Patients

Objectives: Timely access to hearing technology is paramount to ensure early auditory access to the sounds needed for listening and learning in children with early hearing loss (HL). Although children typically move to cochlear implants (CIs) after first having tried hearing aids (HAs), there are some cases where the HA trial may create unnecessary additional delays. This clinical focus article presents three categories of patients where implantation appears warranted without an HA trial. Method: This study examines 3 years of retrospective chart data for pediatric CI patients at a tertiary care center who did not complete an HA trial before surgery. Results: We identified 22 cases and examined their diagnostic audiological profiles and preimplant trajectory of care. Our results coalesced around three broad categories where omission of the HA trial appears warranted: cases of late-onset/progressive HL, cases of children lost to follow-up after newborn hearing screening, and cases of auditory neuropathy spectrum disorder where hearing technology was deferred until behavioral testing was possible. Following surgery, we observed wide variability in device use rates, suggesting that some families may struggle with full-time use of CIs despite the streamlined candidacy process. Conclusions: Taken together, our results show that, in appropriate cases, CIs may be considered for children with HL without first completing an HA trial. This has important implications for closing the timing gaps introduced by loss to follow-up in the United States' national Early Hearing Detection and Intervention program.