Referral criteria for cochlear implantation assessment

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  • No longer obtaining significant speech understanding with maximal amplification – i.e SDS score
  • Post-lingual severe to profound hearing loss
  • Single sided deafness (Post-lingual acquired)
  • Mid to high frequency severe to profound hearing loss in 1 or both ears with preserved low frequency hearing at 125 and 500Hz (AES)
  • No upper age limit


  • Severe to profound unilateral or bilateral SNHL on ABR
  • Referral by neonatal/infant hearing screening (AABR)
  • Lack of progress in development of auditory and language skills despite adequate access to sound and amplification
  • Implantation possible from the age of 6m in certain cases


  • The earlier the implantation in children, the better the expected outcome
  • Universal infant hearing screening should be encouraged at all hospitals with high frequency tympanometry, DPOAE and AABR assessments as per the HPCSA position statement
  • Implantation after the age of 3 in a pre-lingual child is associated with a significantly decreased chance of normal language development and main-stream schooling entry
  • Implantation in any pre-lingual patient >7yrs old is not likely to achieve significant speech outcomes