In 1985 professor Clark performed first cochlear implant surgery on a 10 year old child. Ever since the criterion used to determine candidacy for a cochlear implant changed greatly. These changes include giving implants to persons with increasing amounts of residual hearing, to persons with increasing amount of preoperative open set perception skills, to children at younger age and to greater numbers of persons with abnormal cochlea’s. The primary reason that selection criteria have changed is that patients with implants are obtaining increasing amounts of open set speech recognition with the available devices. Although this increased performance is largely due to many technology advancements that have occurred in the field of cochlear implantation; it’s also partly due to the fact that patients with greater amount of residual hearing and residual speech recognition skills are receiving cochlear implants.
Evaluation: Before and after undertaking cochlear implantation there has to be an evaluation process.
1. Speech perception Evaluation: The speech perception testing is important part of preoperative and postoperative process especially for the children. The purpose of preoperative testing is to evaluate performance and to determine if the patient’s speech perception skills will likely improve with cochlear implant. Post operatively such tests provide information regarding the speech Cues that are or being perused by the child, May aid programming his or her device and may help to determine auditory for a training goals. The specific test chosen for pre and post-operative evaluations of children will vary greatly because they are dependent on child’s age as well as on his or her linguistic ability.
2. Psychological Evaluation: The psychological evaluation is primarily performed with Pediatric patients. During such assessments child Cognitive abilities are evaluated to rule out factors other than hearing impairment that may be inhibiting the child’s auditory development such as learning disorder, the psychologists also determines if reference to other professionals are necessary prior to and after the child receives an implant.
3. Age of Implantation: There has been a growing trend to decrease the age at which children receive a cochlear implant. Investigations have revealed that doing so will provide children with greater access to auditory information which is crucial for development of speech and language skills, food and drug administration (FDA; USA) has approved children as young as twelve months to get cochlear implant; but children who have meningitis get cochlear implant at the age of six months or even younger age as cochlea can become ossified due to Impact of meningitis on inner ear. It is in place to mention that age onset of deafness, age at implantation, duration of deafness, etiology (congenital Meningitis etc) are important factors to be taken into consideration for undertaking cochlear implantation. Early implantation in children results in highly satisfactory speech perception and production. Such results are crucial in the integration process, first in kindergarten and later in regular schools. A continued psychological and education support is mandatory in each of these schooling phases. It has been observed that post lingually deafened adults who receive cochlear implant show improved speech recognition, performance post operatively. Adult patient who received an implant with a shorter period of deafness achieved highest levels of performance, contrary to those with a longer period of deafness regardless of their age at the time of implantation. However persons with longer period of deafness are also gets benefited but their post-operative improvement has been found to be slower.
Safia Untoo is Speech Pathologist cum Audiologist in ENT Department SMHS Hospital, Srinagar
safiazaid01@gmail.com