title: Parental and program's decision making in paediatric simultaneous bilateral cochlear implantation: who says no and why?
abstract: OBJECTIVE
  To evaluate initial candidacy for bilateral simultaneous cochlear implantation in children.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary academic pediatric hospital.
  
  
  METHODS
  As part of our research protocol all children eligible for cochlear implantation were assessed for suitability to receive a simultaneous bilateral implant. Over a 12-month period (January to December 2007) 78 children received a total of 95 cochlear implants. Children with sequential second implants (24), revision cases (4), and out of province recipients (4) were excluded. The remaining 46 patients were assessed for bilateral simultaneous implantation.
  
  
  METHODS
  Team/parental decision to proceed with bilateral simultaneous implantation.
  
  
  RESULTS
  17 children (37%) received simultaneous bilateral implants. 29 children (63%) were not considered suitable for simultaneous bilateral implantation. Reasons included developmental delay (10), residual borderline hearing in the second ear (9), parental/patient refusal (6), abnormally poor speech development for age (2), and abnormal cochlear anatomy precluding implantation (2). None were considered unsuitable for the more prolonged operative procedure on medical grounds.
  
  
  CONCLUSIONS
  Although bilateral implantation is thought to produce the optimal auditory outcome, not all patients are suitable, nor do all parents wish to proceed, when assessed for simultaneous implantation. Some of these patients are likely to be candidates for sequential bilateral implantation in due course.
authors.affiliation: Cochlear Implant Program, The Department of Otolaryngology, The Hospital for Sick Children, Toronto, Canada. james.ramsden@orh.nhs.uk
authors.forename: James D
authors.initials: JD
authors.lastname: Ramsden
authors.forename: Vicky
authors.initials: V
authors.lastname: Papaioannou
authors.forename: Karen A
authors.initials: KA
authors.lastname: Gordon
authors.forename: Adrian L
authors.initials: AL
authors.lastname: James
authors.forename: Blake C
authors.initials: BC
authors.lastname: Papsin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D003054:Cochlear Implants; D015331:Cohort Studies; D003638:Deafness / Q000601:surgery*; D003657:Decision Making; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000601:surgery; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario; D010290:Parents / Q000523:psychology*; D018579:Patient Selection; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome