Ensuring the long-term use of cochlear implants in children: the importance of engaging local resources and expertise.

Cochlear implantation for children is now a mature service, recognized as being safe and effective. Early identification is enabling implantation to be undertaken in the first years of life, with the likelihood of better outcomes. Traditional models of service delivery provided excellent clinic-based services, with intensive early habilitation. However, the current challenges extend beyond this time frame, and clinic-based services are overstretched with the growing numbers of children with implants. Needs analyses of parents and teachers in Europe provide evidence that they are keen to have regular links between implant center and home and school and that for both parents and teachers a major concern is the long-term management of the technology. There are major challenges, not in the implant clinic, but at home and school where implant systems are used. Implementing complex technology in the child's community in the long term is only possible by engaging parents and the local professionals, particularly teachers, from the outset, and using their expertise. This calls for a critical appraisal of the traditional approach to service delivery. Such engagement of local professionals does not happen automatically but can be achieved by educational programs for parents and local professionals that are adapted to local needs and cultures. Communication between implant center and home and school is essential, ensuring that the technology of implantation is used effectively at all times and is accessible to all wherever they live. This article recommends ways in which parents, teachers, and local professionals can play a central role in the management of children with implants to ensure the successful long-term use of their implant systems. Engaging and using the skills and expertise of those who know the child best, parents and teachers, will not only ensure that implantation is sustainable in the long term in diverse cultures, but is also cost-effective.