Evolution of the indications for cochlear implantation and new frontiers

Aline Gomes Bittencourt, Rafael Da Costa Monsanto, Patrick Rademaker Burke

Research output: Chapter in Book/Report/Conference proceedingChapter


Introduction: Candidacy for cochlear implantation has changed gradually and significantly since the first devices were implanted in 1970s. Objective: To review and discuss the changes in the indications and patients selection for cochlear implantation. Methods: A search in the PubMed, Lilacs and Cochrane databases was performed from december 2013 to january 2014. Results: The first indication for cochlear implantation was for adults (ages 18 and older) with profound bilateral sensorineural hearing loss. The lowering of the permissible hearing loss from profound to severe to profound and the concomitant ability to implant those with some degree of benefit from amplification have been very significant changes. In 1980, the first child (a 9-year-old boy) was implanted, and by 1982, 12 children with age ranges from 3.5 to 17 years had been implanted in the House Ear Institute. The FDA approval for implantation in children was then published in 1986, for children ages 2 years and older, and, finally, In June 1990, the Nucleus-22 channel implant received FDA approval for implantation in children aged 2 years and older. Among the most important changes in the candidacy for cochlear implantation on the last 20 years are: the age of the candidate (children with at least 12 months old and even younger, in selected cases; no maximum age if the patient has no clinical contraindications); presence of residual hearing; the willingness to implant patients with major cochlear malformations (such as Mondini dysplasia, common cavities, hypoplastic cochleae, narrow internal auditory canals and large vestibular aqueducts); patients with abnormalities like cochlear nerve deficiency; and other handicaps concurrent with hearing loss, such as cerebral palsy, autism and blindness. Discussion: Numerous changes have occurred with candidacy, and, in general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Over the last decade, the selection criteria for cochlear implantation has expanded to include children with special auditory, otologic, and medical problems, including children with auditory neuropathy spectrum disorder, cochleovestibular malformations, cochlear nerve deficiency, associated syndromes, as well as multiple medical and developmental disorders. Definitive indications for implantation in these unique pediatric populations currently are still in evolution. Conclusion: Results achieved with cochlear implantation are so successful that candidacy criteria for surgery has broadened substantially in different populations, even in those that the implantation was contraindicated in the past. The candidacy criteria are still in evolution.

Original languageEnglish (US)
Title of host publicationCochlear Implants
Subtitle of host publicationTechnological Advances, Psychological/Social Impacts and Long-Term Effectiveness
PublisherNova Science Publishers, Inc.
Number of pages11
ISBN (Electronic)9781633214873
ISBN (Print)9781633214866
StatePublished - Jul 1 2014
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2014 by Nova Science Publishers, Inc. All rights reserved.


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