Learning Objectives:

Objectives: Accurate prognostication in paediatric cochlear implantation (PCI) is essential for informed counselling of a child's outlook during the pre-operative period. This work sought to devise a methodology by which researchers could more clearly define, locate and evaluate adverse factors in PCI to formulate an accurate prognosis to counsel the family prior to implantation, the key to success in PCI.

Method: Three steps in the prognostic process are addressed 1) the exact site, action, probability and severity of the individual adverse factors are assessed using refined descriptors to more clearly denote the pathology and action of these influences 2) illustration of the anatomical location of the factors along the route of PCI stimulation, location of the pattern of influences and their potential impact on the functional aspects of the auditory pathway 3) an evaluation method is presented that allows location of individual factors, their impact on ability, then an estimation of their cumulative effect, the prognosis. Six domains of ability are assessed: cortical maturation, neurological function, otological, general medical, psychological and family.

Result: Considerable difficulties and deficiencies of prior prognostic works are demonstrated. The work provides a “road map” by which clinicians may assemble an orderly estimation of the threats present in a particular case. The evaluation technique, yet to be validated by clinical research, offers a sensibility method of prognostic assessment in PCI.

Conclusions: PCI prognostication requires precise evaluation of the site, pathology and action of adverse factors with focus on the specific pathology, systematic examination of the auditory pathway and a method of evaluation of the combined effect of several impaired domains. However, the overall impact remains an individual study, case-by-case due to the complexity of each situa, particularly in the complicated management of the child with multiple difficulties.