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Predictive factors for the performance of the second cochlear implant in sequentially bilateral implanted children, adolescent and adults

Introduction Little is known about outcome expectations of the second cochlear implant (CI) in sequentially implanted children, adolescent, and adults, particularly as a function of time interval between the first and second CI. A closer look at subjects who received the second CI relatively late after the first CI is an important aspect for counseling parents as well as professionals of special education and for choosing candidates for a second CI. This is particularly important in developing CI programs, where bilateral CI will eventually become available. Since June 1991 to June 2010 a total of 506 CI were performed in our program, 289 subjects are in active follow up. Bilateral CI became available in April 2000 for selected subjects and was approved by Swiss social security insurance in November 2003 for full reimbursement. One hundred and fifteen of 289 subjects received bilateral CI, a few of them simultaneously, the majority in a two-stage procedure. Simultaneous surgery was performed in 10 children and 3 adults with no residual hearing in the second ear: post-meningitis deafness or acute bilateral sudden hearing loss with no recovery or no response to auditory stimulation in best aided condition fitted with high amplification hearing aids in congenitally deaf children. Sequential surgery was generally performed in subjects presenting some residual hearing in the second ear. A short interval up to 6 months between the two CI was chosen in 22 children, the time gap was 7–12 months in 11 children. The second CI was performed at the time when the hearing skills with the first CI exceeded the other ear fitted with a hearing aid. A long time interval for the second CI occurred in subjects implanted earlier in our program before bilateral CI became available, and in those who had constantly used a hearing aid on the other ear: in 31 subjects the interval ranged between 2 and 5 years, in 20 subject between 6 and 12 years, and in 1 elderly female of 18 years.