Results Seventy-eight patients (51 females and 27 males) were identified for further analysis. The average age at implantation was 14 years. As expected the hearing loss in this group was attributed to a wide range of aetiologies, with the majority being considered congenital or idiopathic progressive. The mean score for speech perception using Bamford–Kowal–Bench (BKB) sentences pre-implant (Bench et al., 1979) was 26.3% (n= 24, range 4–68%). BKB could be administered in 56 patients post-implantation, with a mean result of 63.6% (range 12–100%). The BKB results were 67.9% (n= 34, range 20–100%), 70.5% (n= 32, range 20–100%), and 63.3% (n= 13, range 14–99%) at 1, 2, and 5 years post-implantation. Two patients are non-users and 12 patients are partial users. Fifty-nine of 78 (76%) individuals were subsequently educated within a ‘mainstream’ school or ‘total communication’ (speech and sign language) unit. Discussion Adolescence is known to be a time of great physical, emotional, psychological, and social change. For the deaf adolescent this may include their perception of their deafness and their place in the hearing and deaf communities. There are therefore significant challenges in working with this group; these include issues of consent, managing expectations, achieving the balance of caring for the individual while respecting parental concerns, recognizing motivations and the effect of peer pressure, and liaising with the educational system. These issues apply to all adolescents, including those undergoing cochlear implantation as a child and growing into adolescence. Despite the above issues, this group usually performs well, with the majority attending mainstream schools and achieving a normal educational level (Bosco et al., 2005). Huber et al. (2008) found no significant difference in the educational level of a group of 52 cochlear implant users, aged 12–21, compared to a control population. Those with congenital or progressive hearing loss who are considering surgery during adolescence pose more of a challenge. In a study of 25 children undergoing cochlear implantation between the ages of 8 and 18 years, Dowell et al. (2002) found that three factors have a predictive value for speech perception after implantation: pre-operative open set discrimination score, duration of profound hearing loss, and equivalent language age. Despite this, many studies show that adolescents, even if implanted after a prolonged period of profound hearing loss, can perform well, although there is often a wide variation in outcome (Schramm et al., 2002). Quality-of-life studies also show that cochlear implant recipients of all ages score similarly to control groups of normal hearing peers (Loy et al., 2010). It is therefore important that adolescents considering cochlear implantation are given accurate information, including the variation in outcome and the difficulty in predicting who will benefit most. More recently, many of the issues that apply to cochlear implantation in adolescents have become Correspondence to: S J Broomfield, The Manchester Cochlear Implant Programme, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. Email: steve_broomfield@hotmail.com
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