Candidacy and rehabilitation of adolescents during sequential bilateral cochlear implantation with a long-term interval between surgeries

An algorithm has been developed to accompany adolescents at the stages of determining indications and postoperative rehabilitation for sequential bilateral cochlear implantation with a long interval between operations, minimizing the risk of failure to use a cochlear implant (CI) in the second ear (CI2) and ensuring its effective use. The algorithm includes: 1) 2 groups of factors influencing the results of CI2 - unchangeable (medical and biological) and influenceable (psychological and pedagogical - teenager's motivation for CI2, adequate expectations of the results, regular auditory training with CI2); 2) 4 stages of adaptation to stimulation with CI2 and use of CI1 with CI2; 3) audiological, physiological, psychological, auditory training components of the adaptation process to CI2. The study involved 26 prelingually deaf adolescents aged 10-16 years (mean 13.5±3.1 years) implanted in one up to 3 years, who did not use a hearing aid in the second ear after the surgery. The interval after the first surgery was 8-15 years (9.3±4.4 years). 2 candidates were denied implantation in the 2nd ear because of the low effectiveness of CI1 due to additional severe impairments. In two patients, the decision to perform CI2 was postponed due to the lack of motivation. After 6 months with regular auditory training with CI2 and CI1+CI2 with the participation of parents, all 22 adolescents constantly used both CIs and noted the advantage of use of CI1+CI2. The level of auditory perception with CI2 approached the level of perception with CI1 according to the CAP scale in 64% of adolescents. In 8 patients the auditory perception indices with CI2 were lower than with CI1, primarily due to underdevelopment of phonemic hearing.