title: Not a "sound" decision: is cochlear implantation always the best choice?
abstract: OBJECTIVE
  To review the candidacy criteria used to counsel parents of profoundly deaf children, to determine if these criteria have changed over time, and to evaluate eventual communication outcomes for these patients.
  
  
  METHODS
  Retrospective review of 483 pediatric cochlear implant candidates from September 1995 to December 2006 seen at a tertiary care pediatric hospital.
  
  
  RESULTS
  Out of 483 implant candidates, 191 patients were initially felt not to be favorable candidates based on CI team evaluation. Of this group, 3 had insufficient records to review and were excluded. The remaining 188 patients underwent a detailed analysis of specific possible contraindications to implantation. This included audiologic, medical and psychosocial parameters. The data was divided into two time periods: Group 1 included 44 patients from 1995 to 2000, and Group 2 included 144 patients from 2001 to 2006. In Group 1, there was a higher percentage of children with language deprivation and developmental concerns and patients not ready, compared to Group 2 which had a higher percentage of families not ready and inadequate support systems. Group 1 had a higher percentage of patients who ultimately underwent cochlear implant, but otherwise the two groups were largely similar.
  
  
  CONCLUSIONS
  Analysis of our data showed that the degree of concern that the cochlear implant team has in relationship to specific candidacy criteria has changed over time. Recommendations against a cochlear implant were often revisited after initial concerns were addressed. The use of a team approach, in conjunction with a validation tool, is important for establishing criteria for successful cochlear implantation in children to support appropriate counseling of patients and families and to plan post-implant management.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, United States.
authors.forename: Lynne C Graham
authors.initials: LC
authors.lastname: O'Brien
authors.forename: Margaret
authors.initials: M
authors.lastname: Kenna
authors.forename: Marilyn
authors.initials: M
authors.lastname: Neault
authors.forename: Terrell A
authors.initials: TA
authors.lastname: Clark
authors.forename: Betsy
authors.initials: B
authors.lastname: Kammerer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Johnston
authors.forename: Erik
authors.initials: E
authors.lastname: Waldman
authors.forename: Sarah Pierce
authors.initials: SP
authors.lastname: Thomas
authors.forename: Peter
authors.initials: P
authors.lastname: Forbes
authors.forename: Greg R
authors.initials: GR
authors.lastname: Licameli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D015331:Cohort Studies; D003638:Deafness / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007804:Language Development; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult