The Role of Electrophysiological Testing in Pediatric Cochlear Implantation

  • Karen A. GordonEmail author


When cochlear implants (CIs) were first made available to children, clinicians often cautioned families and caregivers that the implant may or may not provide access to sound. This counseling was based upon uncertainty about each child’s potential to hear with the device. It often took several months of watching and waiting and adjustments to CI stimulation levels before a behavioral test confirmed sound detection. Today, a surgeon and implant team can leave the operating room knowing that the new CI functions and stimulates a response from the auditory nerve, as it is designed to do, by including an electrophysiological measure of auditory activity into the surgical procedure. Knowledge of stimulation levels obtained in the operating room may then be used at device activation to guide programming of stimulation levels needed to obtain a behavioral response.

Electrophysiological measures have provided an important addition to the battery of tests used to manage children with CIs. As will be discussed here, it is best to use these tests in a battery including behavioral measures in much the same way as similar electrophysiological measures are used with behavioral tests to diagnose and characterize hearing loss. The initial electrophysiological test of auditory activity evoked by the newly implanted device in the operating room provides answers to many urgent questions: (1) Does the implant work?; (2) does the auditory system respond to the electrical pulses?; and (3) what stimulation levels are required for hearing?. As the child uses his/her device over time, these questions may repeatedly arise. Additional questions may also emerge including: (1) Does the CI evoke unwanted effects such as nonauditory or other abnormal responses?; (2) is the auditory system developing as expected with the CI?; (3) are bilateral CIs providing accurate binaural cues? Electrophysiological measures can help answer these questions.


Electroencephalography (EEG) Auditory-evoked potentials Auditory event-related potentials Electrically evoked compound action potential of the auditory nerve (ECAP) Electrically evoked auditory brainstem response (EABR) Electrically evoked middle latency response Electrically evoked cortical responses Electrically evoked myogenic response Stimulus artifact Auditory development/function/plasticity Auditory Neuropathy Spectrum Disorder (ANSD) Cochlear implant programming Bilateral cochlear implants 



This chapter contains data collected in Archie’s Cochlear Implant Laboratory ( which is supported by our Cochlear Implant Team including the many children and families we follow in our program. A special thank you goes to Salima Jiwani, Melissa Polonenko, Vijayalakshmi Easwar, and Stephanie Jewell for their contributions to the figures and for reviewing the text and to Editors Drs. Young and Kirk for their helpful edits and suggestions.


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© Springer Science+Business Media LLC 2016

Authors and Affiliations

  1. 1.Archie’s Cochlear Implant LaboratoryThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of Otolaryngology—Head & Neck SurgeryUniversity of TorontoTorontoCanada

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