Pediatric CI 3-60 Guideline: When to Refer Children for a Cochlear Implant Candidacy Evaluation

Pediatric CI candidacy considerations require a holistic approach that incorporates evidence-informed decision-making to accommodate age-related limitations in behavioral testing. These data-driven recommendations support a three-faceted referral guideline for CI evaluation, called CI 3-60: unaided 4FPTA ≥60 dB HL, aided SII ≤0.60, or WRS ≤60% correct (when available) in the ear to be implanted. This pediatric referral recommendation is consistent with current adult CI candidacy evaluation referral guidelines but adds consideration of aided SII to compensate for pediatric limitations in completing open-set speech recognition tasks. While not all children referred for an evaluation ultimately undergo implantation, these guidelines (a) capture a high proportion who would benefit more from a CI than hearing aids, and (b) frame CIs as part of a continuum of hearing technology for children who are deaf or hard of hearing.