In the early days of cochlear implantation, children with additional disorders were being excluded as poor candidates whereas today a large number of children with complex needs are being referred for cochlear implant assessment. However, the related problems include difficulties in the assessment to determine whether a particular child is suitable for cochlear implantation and post-implantation tuning of the device in order to obtain accurate threshold responses to acoustic or electrical stimuli. The behavioural and objective tests of hearing have weaknesses and this study outlines the pros and cons of these tests which should be taken into account when performing them on children with complex needs. The author reviewing all related problems concludes that just because a child has complex needs as well as deafness should not mean he / she is ruled out for consideration for cochlear implantation. However there are issues which need to be addressed with the family prior to a decision. The main problem is that there is a lack of preoperative candidature criteria and postoperative outcome measures specific to children with complex needs. A greater evidence base is needed to allow informed decisions to be made. It seems that cochlear implantation in children with additional disorders has made it more clear than ever that (re)habilitation of these children urgently needs appropriate and well designed outcome measures.

Audiological assessment of children with complex needs.
Midgley E.
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Thomas Nikolopoulos

Department of Otorhinolaryngology, Athens, Greece.

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