ACI Alliance Urges American Academy of Pediatrics to Withdraw Report on Recommendations for Pediatric Cochlear Implants

ACI Alliance says report contains inaccurate and biased information

Published 19 September 2023

Cochlear implants (CIs) are electronic devices that stimulate the auditory nerve through electrodes placed in the cochlea of the inner ear, allowing people to perceive sounds when hearing aids are not effective.

The American Cochlear Implant Alliance (ACI Alliance) has published comments responding to the American Academy of Pediatrics (AAP) report “Hearing Assessment in Infants, Children and Adolescents: Recommendations Beyond Neonatal Screening,” urging AAP to withdraw its report and convene a representative group of clinicians, organizations, and parents to provide an up-to-date, balanced, and representative clinical report on options for children who are D/HH [deaf and hard of hearing].

The AAP's report, published in the August 23, 2023 edition of Pediatrics, covers hearing assessment beyond the newborn period, reviewing risk factors for hearing level change, and offers guidance for pediatric primary care providers on the assessment and care of children who are D/HH. HearingTracker featured the AAP publication in our September 1 Audiologist Informer enewsletter.

The ACI Alliance acknowledges that the AAP clinical report does direct needed attention to the importance of hearing healthcare in children, including assessment protocols and mention of the cytomegalovirus (CMV) as a leading cause of childhood hearing loss. However, it says the report also provides inaccurate or incomplete information on several important topics.

For example, in the ACI Alliance's comments about the AAP report, it states:

The report notes the importance of parent choice but does not provide representational citations on outcomes associated with various communication options. For example, the report includes studies supporting the benefits of ASL but not published papers supporting benefits of listening and spoken language (LSL) without ASL in outcomes for children who are D/HH (Geers 2017, Dettman 2013). The authors pose ASL as a way to prevent language deprivation and optimize brain development without acknowledging the implications of this recommendation for families without experience with hearing loss differences or ASL, who need to learn a second language (which may take two years or more) while their child learns their first language. More than 90% of children who are D/HH are born to two parents with typical hearing, but few studies examine language outcomes for children born to two hearing parents using ASL as their main language—a serious omission. Many families have neither the time nor the resources to learn a second language and then teach it to their child..."
ACI Alliance

The ACI Alliance says that the AAP report does note cochlear implants as an option providing more listening opportunity than hearing aids for some children; however, the report does not discuss current communication outcomes for children with severe to profound hearing levels who do not receive a CI.

ACI also contends the AAP report contradicts screening recommendations by the American Academy of Audiology (AAA, 2011) and, despite emphasizing the importance of hearing in young children, fails to recommend hearing screening for those 6 months to 4 years. Further, the Alliance believes the report "muddles" the distinctions between hearing screenings (typically for deciding if more testing is warranted) versus a hearing assessment or complete evaluation.

Given that many pediatricians are unfamiliar with the options and opportunities for children who are deaf or hard of hearing and how they can play a key role in supporting a child’s hearing loss journey, the Alliance says it was “disappointed with the report’s inaccurate and biased information.” It is urging AAP to withdraw and rework the report and use a wider range of experts that will result in an "up-to-date, balanced, and representative clinical report on options for children who are D/HH."

Source: ACI Alliance