Cochlear implants are no longer considered new or experimental options in the rehabilitation of children with hearing loss. They are currently widely used as a treatment for sensorineural hearing loss (SNHL) in carefully selected patients. Cochlear implants restore sound awareness in children who previously had serviceable hearing and can provide this capacity to those who have had an absence of hearing from birth. The use of cochlear implants can improve communication skills in children with severe to profound sensorineural hearing loss who do not benefit from conventional hearing aids.

A cochlear implant consists of an externally worn speech processor and headset and a surgically implanted receiver-stimulator. The headset consists of a microphone and a transmitter. The microphone picks up the sound and the speech processor encodes the sound into an electric signal. The signal is then sent transcutaneously to the receiver-stimulator by the transmitter. The receiver-stimulator electrically stimulates the spiral ganglion cells of the cochlear nerve, resulting in auditory perception.<sup>17   Minisystem 22-Audiologist's Handbook Denver, CO: Cochlear Corporation (1993). 

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Despite wide acceptance of cochlear implants for adults with severe to profound sensorineural hearing loss, cochlear implantation in children remains controversial in both the medical and lay communities. It is widely recognized that auditory stimulation should be provided as soon as possible after hearing loss is identified to best ensure that a child can maximize residual hearing and reach auditory language and learning potential. Children deafened after or around the time of rapid language acquisition (postlingual or perilingual) are at significant risk for deterioration of verbal language skills without continued auditory input. Also, evidence from animal models strongly suggests that peripheral auditory stimulation may be necessary for the development and maturation for central auditory pathways.<sup>13 Kveton J., Balkany T.J. Status of cochlear implantation in children J Pediatr 1991 ;  118 : 1-7

Cliquez ici pour aller à la section Références</sup> Despite the benefits of auditory stimulation, there is concern among some educators of hearing-impaired children regarding the safety and desirability of chronic electric stimulation of the cochlea in children,<sup>8 Gibson W.P.R. Opposition from deaf groups to the cochlear implant Med J Aust 1991 ;  15 : 212-214

Cliquez ici pour aller à la section Références</sup> although no clinical evidence exists of functional degradation or intracochlear injury in more than 3000 adult cochlear-implant recipients.<sup>10 House W.F. Cochlear implants in children: Past and present perspectives Am J Otol 1991 ;  12 : 15-25

Cliquez ici pour aller à la section Références</sup> Also, some members of the deaf community have expressed their concerns that implantation adversely affects deaf children's mental and social health and development,<sup>1 Brown C.L. The Challenge TBC News 1991 ;  36 : 5

Cliquez ici pour aller à la section Références</sup> although no evidence supports these notions.

Determining the degree of hearing loss and a child's ability to capitalize on residual hearing through appropriately fitted hearing aids are the major challenges for all caregivers of children with hearing loss. Most children with severe to profound SNHL can benefit from hearing aids and therefore are not candidates for cochlear implantation. Facilitating the development of spoken language is the rationale for cochlear implantation for children. The challenge is designing appropriate testing protocols to accurately identify those children who will be more likely to realize spoken language through the use of a cochlear implant compared with that which they could achieve through the use of hearing aids.

The purpose of this article is to provide the pediatrician and other health care providers of children with information regarding this evolving technology and its place in the treatment of hearing-impaired children. It provides an overview of the evaluation process, surgery, and postoperative programming and training that is required. The benefits from cochlear implantation in the pediatric population are highlighted also. The decision to provide a child with an implant requires a commitment from healthcare providers, family members, and educators who are involved with the process. This commitment reflects the fact that the decision to implant is a means to an end and not an end in itself.