Counseling Pre-operative Counseling : It is absolutely essential to counsel the implant candidate, parents and family members about the surgery , the reasons for wanting a cochlear implant, expectations of benefit and outcomes, motivation for use, and rehabilitation/educational considerations. Time must be taken to discuss realistic expectations and the habilitation required to obtain maximum post-operative benefit.

The candidate and family must accept the deafness and not view the implant as a 'miracle cure'. The candidate and family must be fully aware of the limitations as well as the benefits of the device, the risks associated with surgery and post-operative activities, and the commitment required for habilitation.

In many clinics around the world, a 'contract' or statement of understanding between the clinic and the family is signed, acknowledging all the issues that have been discussed and committing to all the required post-operative follow up.

The following factors should be included in the pre-operative counseling where applicable : Long duration of deafness  Age at onset of deafness Aetiology  Surgical complications and risks Post-operative limitations of device (e.g.. sport, medical procedures)

Pre-operative Counseling Before the implant is activated for the first time, the patient/family should know what is expected of them during the post-operative sessions and what to expect during the first few weeks after activation. The clinician should reiterate the realistic expectations discussed pre-operatively, highlighting potentially difficult communication situations such as background noise, group situations, and use of telephone. It is also helpful to discuss operation of the speech processor prior to the first tune up session so that patient/family feels comfortable to take the device home after the first session. For children, it is necessary to decide how the device is to be worn on the body, and to start practicing this before the first activation session. This will familiarize the patient with the device beforehand and ensure faster adaptation. Counseling is an ongoing process for cochlear implant users and their families, especially with young children who require intensive ongoing habilitation before significant progress can be seen.

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