SLPNarrative ReviewEar and hearing2022

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single-Sided Deafness.

Lisa R Park, Amanda M Griffin, Douglas P Sladen and 2 others

PMID 35213890

WHAT IT FOUND

Children with single-sided deafness who receive cochlear implants report better hearing in noise and improved sound localization.

These guidelines recommend evaluating candidacy based on speech-in-noise performance and aided speech intelligibility, rather than standard audiogram thresholds alone.

Key findings

01Cochlear implants for children with single-sided deafness are associated with improved speech understanding in noise, tinnitus suppression, and sound localization.

02Standard FDA hearing thresholds for implantation may be too restrictive; children with a three-frequency pure-tone average of 60 dB or higher, or an aided speech intelligibility index below 0.65, should be considered for evaluation.

03Clinical assessment must include speech-in-noise testing with spatially separated targets and maskers to evaluate binaural benefits, as standard word recognition tests do not capture real-world listening difficulties.

STILL TO COME

How it was doneWhat they foundWhat it means for SLPs

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What it does not show

The guidelines are based on expert consensus and limited literature, primarily from adult studies or small pediatric series, rather than a systematic review of high-quality evidence. Long-term outcomes for speech, language, cognition, and academic performance in children with SSD and cochlear implants are still unknown. There is no validated pediatric measure for tinnitus, and standard localization testing is often clinically impractical, forcing reliance on subjective questionnaires. Current FDA age limits (5 years) and duration of deafness limits (10 years) are based on adult data and may not reflect the neuroplastic advantages of earlier implantation in children.

Declared interests

The authors declare no conflicts of interest. The work was supported by non-U.S. government funding.

The easy way to misread this

Do not assume cochlear implantation guarantees normal hearing or binaural integration. Outcomes vary significantly, and the contribution of therapy versus the device itself cannot be separated. These guidelines are expert recommendations, not evidence from a randomized trial, so individual patient response may differ from the reported trends.

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