PP1106 - Managing Aversion to Cochlear Implants in a Non-Verbal Pediatric Patient

Abstract: Summary of interdisciplinary clinical practices that helped a profoundly deaf eight year old child begin using her cochlear implants and develop language. When initially presenting to our team, the child had no verbal or manual language modality and an extreme aversion to utilizing her cochlear implants. After implementing evidence-based clinical practices and a team approach, this child is now a full-time user of both of her cochlear implants and is rapidly developing both spoken and manual language.

Summary:

An eight year old child, who we will refer to as TV, initially presented to the Cleveland Clinic in March of 2020. His family had recently relocated to Cleveland from India. TV was diagnosed with congenital, sensorineural hearing loss in the United Kingdom, where the family lived until she was about 3 years of age. She underwent bilateral cochlear implantation at 13 months of age in the UK and was a good user of her devices until her toddler years, when she became very averse to them. When the family relocated to India, resources were scarce and TV went many years without any exposure to a manual language modality in the absence of sound due to refusal to wear her cochlear implant processors.

At her initial visit with us, TV presented with extreme aversion to even seeing her cochlear implant processors and grave behavioral concerns. Utilizing a CT scan, integrity testing, and Neural Response Imaging (NRI) under sedation, our team was able to identify 3-4 extracochlear electrodes per side and verify the implants were functioning properly. TV was enrolled into a total communication education program, her non-verbal IQ and behavioral needs were addressed by a neuropsychologist, and parents were simultaneously tasked with having TV wear her processors without power to overcome the physical fear of them. Once TV was able to wear the processors, she was given conservative, progressive programming, with the extracochlear electrodes disabled, to eventually reach optimal stimulation levels over a period of 2-3 months.

Approximately three years later, TV is now a full-time user of her cochlear implant processors and has rapidly developed spoken and manual language thanks to our team approach, family-centered care, and her educational program. Her behavior has improved immensely and she is receiving gender affirming care as she has been able to communicate she identifies as female (her assigned sex at birth was male). She and her family’s quality of life has also immensely improved as TV is now able to easily communicate her wants and needs.  

This clinical poster will highlight the steps that were taken in a challenging case of an older, cognitively intact child who was unable to communicate why she was so averse to utilizing her cochlear implants. It will highlight the importance of holistic, interdisciplinary care in managing the needs of complex pediatric patients with hearing loss.