The Yorkshire Auditory Implant Service
Sequential Bilateral Cochlear Implantation in
Children:
Assessment, Rehabilitation and Outcomes
Jane Martin, Catherine Totten, Catherine Killan and Prof. Chris Raine
NICE Guidance January 2009
National Institute for Health and Clinical Excellence
• ‘Simultaneous cochlear implantation is
recommended as an option for the following
groups of people with severe to profound
deafness who do not receive adequate benefit
from acoustic hearing aids:
• Children
• Adults who are blind or who have other
disabilities that increase their reliance on
auditory stimuli…’
Sequential Implantation
• ‘Bilateral cochlear implantation carried out in
separate operations is not recommended as
an option for people with severe to profound
deafness. However, people who had a
unilateral implant before publication of this
guidance, and who fall into one of the
categories described for bilateral
implantation….’ following assessment by the
responsible clinician.
YAIS Response
• Numbers of potential candidates
• General Newsletter
• Devised Sequential Cochlear Implant Profile
(SCIP)
• Targeted letter
Assessment
SEQUENTIAL COCHLEAR IMPLANT PROFILE (SCIP)
Factors
Chronological age (current)
Age at first implant (congenital)
Otology (ear infection and scan results)
Medical (fitness for GA)
Hearing history of non-implanted ear
Child’s ability to participate in programming
Consistent unilateral c.i. use established
Development of functional spoken language
Family commitment to long term support
Educational support
Chronological Age
Sequential Cochlear Implant Profile (SCIP) definitions
Assessment Factors
No Concern
Mild to Moderate
Concern
Great Concern
a) Plasticity of
auditory system
< 3.5 years
4 – 7 years
8 years unless
bimodal
b) Ability to adjust
to 2nd implant
< 7 years
7 – 12 years
> 12 years
Chronological Age
Demographics of Implantees
• 78 children
• Age range at 1st CI: 1yr 2mths – 7yrs 9mths
• Age range at 2nd CI: 1yr 11mths – 15yrs 3mths
• Length of sequential use: 4 months – 7yrs
8mths
Age at First and Second Implant
30
Age at 1st CI
25
Number of Children
Age at 2nd CI
20
15
10
5
0
1-2
2-3
3-4
4-5
5-6
6-7
7-8
8-9
Age in years
9-10 10-11 11-12 12-13 13-14 14-15 15-16
Interval Between the First and
Second Implants
14
Number of Children
12
10
8
6
4
2
0
0-1
1-2
2-3
3-4
4-5
5-6
6-7
7-8
8-9
Time between implants in years
9-10
10-11 11-12 12-13
Rehabilitation Support
Support and guidance offered to the
child/teenager, the family and local
professionals
• Consistent use of both speech processors
• Auditory training for second side (depending
on age and gap)
• Expectations, motivation and commitment,
long term
Outcomes-2nd Ear Cochlear Implant Use
14
12
Number of Children
10
8
Non-users
Poor users
6
Good users
4
2
0
0-1
1-2
2-3
3-4
4-5
5-6
6-7
7-8
8-9
9-10 10-11 11-12 12-13 14-15 15-16
Age at 2nd Implant (years)
n = 78
Outcomes-Categories of Auditory Performance
CAP 6 months - 2nd ear
L3
7%
L4
22%
L6
49%
Level 3
Level 4
L5
22%
Level 5
Level 6
CAP 12 months - 2nd ear
Level 7
L7
3%
N = 45
L4
13%
L6
65%
N = 37
L5
19%
ABC-York Crescent of Sound: Test Battery
• The Left-Right
Discrimination Test
• The Toy Localisation
Test
• The Toy Discrimination
Test (Spatial Release
from Masking for
Speech)
• The BKB Sentence Test
Two ears better than one in
background noise
7
Speech &
Noise
2nd
1st
6
N = 14
Speech
Benefit (decibels)
5
4
1st
3
2nd
Noise
2
Speech
1
0
2 years
4 years
1st
Noise
2nd
Left / Right Discrimination
Left / Right Discrimination at 2
years
6
10
Left / Right Discrimination
at 4 years
unable to
tell right
from left
can tell
right from
left
16
Summary of Outcomes
• Two non-users
• Two thirds of children have achieved open-set
sentence understanding using the 2nd implant
alone by 12 months
• Functional listening ability improves over time
– Localisation ability
– Listening in background noise
Conclusions
• Flexible approach to rehabilitation support,
particularly targeting 9-11 age group
• Recognition of long-term commitment and
motivation is essential
– Child
– Parents
• Co-operation from local professionals
Thank You