Preoperative CI Assessment in Children

In children: simultaneous bilateral cochlear implantation is possible at MHH

The purpose of the preoperative assessment, which usually takes three days and is carried out on an inpatient basis, is to find out if your child meets the requirements for cochlear implant (CI) surgery.

This includes:

  • Evaluation of inner ear damage
  • Evaluation of the inner ear in terms of requirements for electrode insertion
  • Testing of residual hearing (is it insufficient for speech understanding despite hearing aid fitting, so that the child is unable to acquire speech?)

This assessment necessitates a medical evaluation carried out by ENT specialists, subjective and objective hearing tests, a computed tomography (CT) scan and a magnetic resonance imaging (MRI) examination. Young children undergo this part of the assessment (objective hearing tests including removal of pharyngeal tonsils and eardrum incision) under general anaesthetic because of their inability to cooperate. They need to be hospitalised for three days. Instead of subjective information, objectively measured auditory potentials are used.

Not only is the child’s medical suitability for implantation evaluated, but an assessment from a speech and language therapist’s perspective is also carried out. The parents will have a consultation session in close collaboration with the ‘Wilhelm Hirte’ Cochlear Implant Center in Hannover and early-intervention therapists at home. A preoperative interview with a technician is also scheduled.
To conclude the preoperative assessment process, a final meeting is held with Professor Thomas Lenarz (Director of the Department of Otorhinolaryngology) or his deputy. All evaluations and findings – including those obtained elsewhere (or earlier) – will be reviewed and taken into consideration for the overall assessment., A decision in favour or against implantation will be reached in conjunction with you (the parents). This does not mean that you have to decide straight away, but we will clearly state whether or not we feel cochlear implantation is a viable option for your child. Of course, the final decision is up to you. It is our duty to tell you, on the basis of our extensive preoperative assessment, what the prospects are of your child’s developing optimally enhanced hearing with a cochlear implant. If unresolved questions remain, further examinations may be necessary or additional external documents or findings may have to be obtained. A new outpatient appointment in our department may then be necessary. However, this is the exception and not the rule.

Sometimes the decision must be postponed. To give an example: it may be that, at the time of the preoperative assessment, we cannot determine with absolute certainty whether your child still has any usable residual hearing left. In this case, optimal hearing aid fitting and further observation will bring greater clarity. As a rule, three months are sufficient.

Hearing loss acquired after meningitis or due to severe inner ear malformation usually necessitates immediate bilateral implantation before meningitis-induced ossification of the cochlea sets in. If a child has a severely malformed inner ear, it can be assumed that no residual hearing is left so that no further time should be lost in helping the child achieve optimal hearing and speech development.