Support for deaf children aged 0 to 5 years: Guide

Early Amplification

Universal Newborn Hearing Screening has been implemented to detect permanent childhood hearing loss (PCHL) early, with the ultimate goal of improving outcomes through early treatment.  Following early detection we should be aiming for early amplification.

Evidence from Research has shown that having a hearing loss in the early years of life can significantly increase the risk of not developing spoken language.  The risk can be decreased using technology which stimulates the auditory brain/language centre, together with high quality input and interaction.

The NHS newborn hearing screening programme screens all newborn babies within 26 days of birth for possible hearing difficulties.  Babies who at screening are identified as having possible hearing difficulties are referred to NHS audiology services.  Those who are then confirmed deaf should receive a hearing aid within 2 months.  This initial diagnosis is followed by ongoing support, which includes regular audiological assessment and consideration of the appropriateness of a cochlear implant (usually within the first year).

The NICE guidelines (2009) ‘Cochlear implants for children and adults with severe to profound deafness’ give the criteria for consideration of cochlear implantation.  These guidelines ’have been updated and the final  guidance was published on 7 March 2019.   You can access the recommendations here. 

The update explains:

For the purposes of this guidance, severe to profound deafness is defined as hearing only sounds that are louder than 80 dB HL (pure-tone audiometric threshold equal to or greater than 80 dB HL) at 2 or more frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz and 4,000 Hz) bilaterally without acoustic hearing aids. Adequate benefit from acoustic hearing aids is defined for this guidance as:

• for adults, a phoneme score of 50% or greater on the Arthur Boothroyd word test presented at 70 dBA
• for children, speech, language and listening skills appropriate to age, developmental stage and cognitive ability. [2009, amended 2018]

The new NICE Guidance related to the criteria for consideration for cochlear implantation can be accessed here.

The British Cochlear Implant Group also give these referral guidelines for Cochlear Implant assessment and

The British Cochlear Implant Group also give these referral guidelines for Cochlear Implant assessment and have issued a statement .

Candidacy criteria for cochlear implants varies across the globe.  The biggest variations are in age limits and audiometric criteria.  See a summary of worldwide candidacy criteria here.

For more information please also see:

• Cochlear Implants – NDCS
• British Cochlear Implant Group

Research on children with severe/profound hearing loss who receive cochlear implants, has found that better speech and/or language outcomes have been associated with:

• early cochlear implantation before age 18 months¹⁴ or before age 12 months^15,16
• early bilateral implantation^17,18,19
• earlier fitting of amplification devices^20,21
• the utilization of newer generations of cochlear implant (CI) technology²² with their improved acoustic processing capabilities.