Cochlear implant surgical issues in the very young child.

Early cochlear implantation has become more acceptable due to neonatal hearing screening programmes with neurophysiological hearing assessments, allowing early diagnosis in the first few months of life, of profound hearing loss. Cochlear implantation is considered for the child with profound hearing loss, 12 months and younger, in order to enhance early access to hearing and enabling better language outcomes. Surgical issues for the very young child include; reliable pre-operative work up, with objective audiological testing and radiology; limited anatomical access and facial nerve monitoring; bone marrow distribution in the petrous temporal bone in the younger child, and how that resolves in the first 12 months; and the influence of acute otitis media and otitis media with effusion on cochlear implantation in children 12 months and younger.