2026 Early Hearing Detection & Intervention Conference
March 15-17, 2026 • Jacksonville, FL
3/10/2025 | 10:35 AM - 11:05 AM | When to refer children for a CI candidacy evaluation: A 60/60 guideline for pediatrics | 308
When to refer children for a CI candidacy evaluation: A 60/60 guideline for pediatrics
Introduction
Despite the overwhelming success of cochlear implants (CIs), only 50% of children with significant sensorineural hearing loss in the United States receive this treatment option. One contributing factor to this underutilization is uncertainty surrounding when to refer for a CI candidacy evaluation. This study analyzed hearing evaluations from children with known hearing losses to develop updated pediatric CI referral guidelines.
Methods
Retrospective data were collected at three progressive, major academic medical centers. The most recent hearing evaluation obtained between Jan 2020 and Dec 2021 were captured for 1,230 children (0-14 years) with known hearing losses. Data points included hearing device configuration, age, CI candidacy referral recommendation, CI recommendation, audiogram thresholds (four-frequency pure-tone average, 4FPTA), unaided & aided word recognition, and unaided & aided speech intelligibility index (SII).
Results
Eighty-five percent of the 345 children (526 ears) referred for CI candidacy evaluation received a CI recommendation. Overall, 94% of ears met at least one of the following criteria: unaided 4FPTA ?60 dB HL, aided SII ?.60, or speech recognition scores ?60% correct. One-third of children who received a CI recommendation did not meet FDA criteria due to asymmetric hearing loss, better thresholds, or younger age.
Conclusions
Pediatric CI candidacy considerations require fluid criteria to accommodate limitations in behavioral testing. These data-driven recommendations support 60/60/60 referral for CI evaluations with unaided 4FPTA ?60 dB HL, aided SII < .60, or speech recognition scores <60% correct (when available) in the ear to be implanted. This recommendation echoes adult recommendations with additional consideration of aided SII. Not all children referred for an evaluation undergo implantation, but these guidelines capture most children who would benefit more from a CI than hearing aids and begins the conversation of CIs as part of a continuum of hearing technology for children who are deaf and hard of hearing.
- Recognize three primary determinants of pediatric cochlear implant candidacy
- Describe pediatric hearing technology along a continuum of care.
- Identify three off-label considerations for cochlear implant candidacy in children.
Presentation:
This presentation has not yet been uploaded.
Handouts:
3545975_18228LisaPark.pdf
3545975_18228LisaPark_1.pdf
Transcripts:
CART transcripts are NOT YET available, but will be posted shortly after the conference
Presenters/Authors
Lisa Park
(Primary Presenter), University of North Carolina at Chapel Hill, lisa_park@med.unc.edu;
Dr. Park is a research audiologist, division chief of the Children's Cochlear Implant Center at UNC, and Assistant Professor in the Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina at Chapel Hill. She received her AuD from the University of Florida and her master’s degree from Washington University in St. Louis. Her clinical research focuses on expanding cochlear implant indications for children who are deaf and hard of hearing. She investigates optimal programming for children who are considered non-traditional pediatric cochlear implant recipients, and associated outcomes on measures of speech perception, spatial hearing, and quality of life.
ASHA DISCLOSURE:
Financial -
• Receives Grants for Independent contractor from MED-EL.
Nonfinancial -
No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
Financial -
Financial relationship with MED-EL.
Nature: Research grant provided to university.
Nonfinancial -
No relevant nonfinancial relationship exists.
Andrea Warner-Czyz
(Co-Author), The University of Texas at Dallas, warnerczyz@utdallas.edu;
Andrea Warner-Czyz, an associate professor at The University of Texas at Dallas, focuses her research on the identification of risk and protective factors that influence communication and quality of life in children and adolescents with cochlear implants. Her current work continues to explore the intersection among social communication, speech perception, and speech and language skills to understand components that contribute to peer relationships and quality of life in pediatric cochlear implant users.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exists.
Nonfinancial -
• Has a Professional
(Chair of the Board of Directors for the American Cochlear Implant Alliance)
relationship for Board membership.
AAA DISCLOSURE:
Financial -
Financial relationship with American Cochlear Implant Alliance.
Nature: Chair of the Board of Directors.
Nonfinancial -
Non-Financial relationship with American Cochlear Implant Alliance.
Nature: Chair of the Board of Directors.
Jourdan Holder
(Co-Author), Vanderbilt University Medical Center, jourdan.t.holder@vumc.org;
Jourdan Holder, Au.D., Ph.D., CCC-A completed her Bachelor of Science at the University of Texas at Austin in Audiology followed by her Doctor of Audiology at Vanderbilt University. She then spent two years working as a clinical and research audiologist at Vanderbilt. After gaining clinical experience and observing the need for research in the area of cochlear implants, she began her Ph.D. at Vanderbilt in 2018. Dr. Holder completed her Ph.D. at Vanderbilt in 2021 in the Department of Hearing and Speech Sciences with a specialization in Cochlear Implants.
Currently, Dr. Holder is an Assistant Professor at Vanderbilt University in the Department of Hearing and Speech Sciences with a joint appointment in the Department of Otolaryngology. She serves adult and pediatric cochlear implant recipients in the clinic in addition to conducting research in Vanderbilt’s Cochlear Implant Research Lab. Her primary research interests include understanding and improving speech perception and quality of life outcomes for cochlear implant recipients using a variety of different methods and improving access to cochlear implant technology, especially for non-traditional pediatric candidates. Her work has resulted in over 25 peer-reviewed publications and numerous scientific presentations nationally and internationally.
ASHA DISCLOSURE:
Financial -
Nonfinancial -
AAA DISCLOSURE:
Financial -
Nonfinancial -