Pediatric CI 3-60 Guideline: When to Refer Children for a Cochlear Implant Candidacy Evaluation.

This is a look back at existing clinic records, not a trial. No child was followed through to surgery and no outcomes were measured, so the paper says nothing about who actually benefits from an implant. The authors did not assess whether the decisions to recommend or not recommend an implant were appropriate, and did not record why a referral or an implant was not recommended. The four-frequency average and the aided SII had good sensitivity but poor specificity (24% and 47%), so using them alone will refer many children who turn out not to be candidates, with extra appointments, cost and worry for families. Only about a quarter of the children could complete open-set word recognition testing, so the most accurate of the three measures is unavailable for most young children. Children who could not do behavioural hearing testing (infants, children with other conditions) were excluded, as were children who were referred but did not attend, so the sample is those who could be tested and who turned up. All three centres were major implant centres in the United States and the sample came from one two-year window.

Do not treat these three thresholds as a validated rule for who will benefit from a cochlear implant. The study only recorded which children were referred and recommended for an evaluation at three centres; it did not follow any child through to surgery or measure outcomes, and the authors state they did not assess whether the candidacy decisions were appropriate.