What’s the Evaluation Process for Children with Severe Hearing Loss
Key Pointers at a Glance:
- Cochlear implants are considered for children with severe to profound hearing loss who don’t benefit enough from hearing aids.
- ENT specialists work closely with audiologists and speech-language therapists to assess hearing, speech development, and overall readiness.
- The evaluation process involves hearing tests, imaging scans, developmental reviews, and family counselling.
- Timing matters, early diagnosis and intervention give children the best opportunity for spoken language development.
What Are Cochlear Implants?
Cochlear implants are electronic medical devices that bypass damaged parts of the inner ear and directly stimulate the hearing nerve. Unlike hearing aids, which amplify sound, cochlear implants send signals to the brain as electrical impulses, allowing the child to perceive sound even with severe inner ear damage.
They are most commonly used in children with bilateral severe to profound sensorineural hearing loss who gain limited benefit from traditional hearing aids.
When Do ENT Specialists Start Considering Cochlear Implants?
ENT specialists begin to consider cochlear implants when:
- A child is diagnosed with severe or profound hearing loss, especially if both ears are affected
- Hearing aids have been tried, but speech and listening skills are not developing as expected
- There are concerns about delayed speech milestones despite early amplification
- Audiological and medical assessments suggest limited inner ear function
The earlier the identification and decision-making process, the better the outcomes for speech and language development, ideally within the first 12 to 18 months of life, though older children may still benefit depending on circumstances.
Step-by-Step: The Cochlear Implant Candidacy Evaluation
1. Comprehensive Hearing Tests
ENTs work closely with audiologists to conduct:
- Behavioural hearing tests (age-appropriate)
- Electrophysiological tests (e.g. Auditory Brainstem Response – ABR, Auditory Steady-State Response – ASSR)
- Aided testing (how well a child hears with hearing aids)
These help determine how much access the child has to speech sounds, and whether the hearing loss is permanent and severe enough for implant consideration.
2. Speech and Language Assessments
Speech-language therapists assess:
- Speech milestones (babbling, responding to sounds, word development)
- Social interaction and responsiveness to spoken language
- How much the child benefits from hearing aids in everyday settings
If a child shows minimal spoken language progress despite early hearing aid use, cochlear implants may be explored.
3. Medical and Imaging Evaluation
ENT specialists will review the child’s:
- Middle and inner ear anatomy (via CT or MRI scans)
- Medical history (e.g. infections, syndromes, neurological concerns)
- Suitability for anaesthesia and surgery
The goal is to ensure that the inner ear (cochlea) and hearing nerve are healthy enough to receive and respond to the implant.
4. Family Readiness and Counselling
Parents and caregivers play a central role in the decision. ENT doctors and the cochlear implant team will explain:
- What the surgery involves
- What to expect during activation and rehabilitation
- The need for regular follow-up and speech therapy
Families are guided through the process, and their questions and preferences are considered every step of the way.
Frequently Asked Questions (FAQs)
1. At what age can a child get a cochlear implant?
Implants can be considered from as young as 12 months, or earlier in certain cases. The key is early, accurate diagnosis and timely intervention.
2. Can children with other medical conditions still get implants?
Yes, depending on the condition. A thorough ENT and medical evaluation is needed to assess overall suitability and expected benefit.
3. Will my child still need speech therapy after the implant?
Yes. Ongoing auditory-verbal therapy and family support are essential to help children learn to understand and produce speech after implantation.
4. Can cochlear implants be done for one ear only?
Yes. In some cases, unilateral implantation is recommended first, with the second implant considered later if needed. Others may benefit from bilateral implants depending on their hearing profile.
When to Seek a Cochlear Implant Evaluation
If your child has been diagnosed with severe or profound hearing loss, or if you’ve noticed that speech and listening progress remain limited despite wearing hearing aids, it may be time to consult an ENT specialist.
At Dr Lynne Lim Ear Nose Throat Head and Neck Surgery Centre, Dr Lynne Lim, a Senior Consultant Ear Nose Throat – Head & Neck Surgeon, has extensive experience in the assessment and care of children with hearing loss.
The clinic offers:
- Age-appropriate hearing and auditory testing
- In-depth speech and developmental assessments
- Imaging and medical evaluations
- Coordination with audiologists, speech therapists, and implant programme teams
Book an appointment today if you have questions about your child’s hearing, early diagnosis can make a lifelong difference.
