Up to half of children who meet criteria for cochlear implants don’t get them. In a recent journal article, a Children’s Health otolaryngologist explores treatment eligibility and considerations.
An estimated 1 in 500 children in the U.S. are born with severe to profound sensorineural hearing loss or develop it later on. Most of these children can benefit from cochlear implants because hearing aids are unlikely to provide meaningful sound. For optimal outcomes, children should get cochlear implants before their first birthdays.
“The understanding of who is a candidate for cochlear implants and how to evaluate for treatment has evolved,” says Kenneth Lee, M.D., Ph.D., Director of the Pediatric Cochlear Implant Program at Children’s HealthSM and a Professor at UT Southwestern. “Still, there are issues unique to pediatric patients that providers should consider before recommending this treatment.”
Dr. Lee is a leader in research to pioneer new techniques to treat hearing loss in children, including the development of new cochlear implants and bone conduction devices. He was the senior author of an April 2024 Journal of Audiology and Otology article that explores pediatric cochlear implantation. The article provides guidance for physicians treating children with severe-to-profound bilateral or unilateral sensorineural hearing loss (SNHL). In this Q&A, Dr. Lee shares what providers need to know.
How important is early identification and intervention when considering cochlear implants for children?
Early intervention is extremely important. Damage to or a loss of sensory hair cells in the cochlea means there’s no stimulation to the auditory nerves. Over time, the nerves gradually degenerate. Even if a child isn’t a candidate for cochlear implantation, a hearing aid can keep these nerves working as well as keep the hearing regions of the brain active, allowing for some sound sensation and potentially other treatments in the future.
How has cochlear implantation as a treatment for pediatric hearing loss changed over the years?
With new technologies and safer surgical procedures, we’re placing cochlear implants earlier than ever. Toward the end of 2025, the FDA lowered the minimum age for one device to 7 months for infants with profound bilateral SNHL. We probably won’t go much lower than that because the Centers for Disease Control and Prevention (CDC) recommends that infants and children have all doses of the pneumococcal vaccine before getting a cochlear implant.
The vaccine protects against pneumococcal meningitis, a complication that can occur when a child has acute otitis media and inner ear fluid that is in direct contact with cerebrospinal fluid. Because we create an opening into the inner ear when placing a cochlear implant, the risk of meningitis increases for these patients.
For infants 9 months and older, we now have several implantable devices to choose from, allowing for the selection of a device that works best for a child’s anatomy. Cochlear implants were first approved in 1990 for children 2 and older. But studies show that getting an implant during infancy can make a significant difference in how well a child understands and uses speech.
What factors help determine if a child is a good candidate for a cochlear implant?
Aside from age, anatomy and severity of hearing loss, we also have to consider things like cognitive and developmental concerns. A child with sensory issues may not do well having an external transmitter behind their ear. The transmitter can also bump against headrests, making it uncomfortable for children who use wheelchairs.
Whether hearing loss occurs in one or both ears is no longer a deciding factor. Previously, cochlear implants were reserved for children with bilateral hearing loss. But studies show that children with single-sided deafness have more educational challenges and are more likely to be held back a grade compared to their classmates. Single-sided deafness makes it harder for a child to understand their teachers in a noisy classroom. A cochlear implant can help them hear in both ears, which is important for sound location and speech perception.
What are some surprising takeaways from your paper?
It was reassuring to see how well children fare with these implants and rewarding to see the difference they make in a child’s ability to engage in their world. The research shows that:
96% wear their device every day
87% understand speech without reading lips
66% can have a phone conversation without needing visual cues
Parents say it’s reassuring to understand the cause of their child’s hearing loss (specifically, that they didn’t cause it), as well as what to expect as their child grows up.
What advice do you have for parents who are considering cochlear implants for their child?
When possible, it’s best to have the procedure at a pediatric center with highly experienced surgeons. In most cases, placing a cochlear device is a safe, straightforward procedure. However, every child’s ear anatomy is unique and surgical complications are always a possibility. When you go to a center that performs a high volume of cochlear implants – an average of 50 to 60 per year – the surgeons have the experience and expertise to manage issues should they arise.
These surgeons are also experts at revision surgery. While cochlear implant failure isn’t common, children are more likely to need another surgery if the device stops working after a fall, sports injury or other trauma.
The Pediatric Cochlear Implant Program at Children’s Health
Our Pediatric Cochlear Implant Program brings together some of the world’s leading specialists dedicated to improving speech and language outcomes in children with hearing loss. Children receive care from otolaryngologists, as well as developmental behavioral pediatricians, audiologists, speech pathologists, psychologists and social workers. We also provide ongoing care and support at our Family-Focused Center (FFC) for Deaf and Hard of Hearing Children.
Learn more about our Cochlear Implant Program at Children’s Health.
