Hearing loss is a partial or total inability to hear sound and it is also referred to as hearing impairment. Hearing loss may occur in one or both ears and may be due to congenital or acquired causes. Congenital hearing loss means that the hearing loss was present right from the time of birth in children and often due to genetic and non-genetic factors. Children can also be affected by acquired hearing loss i.e., hearing loss occurring any time after birth. Acquired hearing loss is often due to ruptured ear drum, excessive noise exposure, and frequent ear infections, etc. In children, whether it is congenital or acquired hearing problems, the ability to learn spoken language is affected and untreated hearing loss often leads to irritability, negativism, anger, social rejection and loneliness, reduced alertness and increased risk to personal safety, reduced job performance and earning power, and diminished psychological, educational and overall health. In most cases, acquired hearing loss can be treated with medical interventions. But some individuals develop permanent hearing loss involving cochlea and auditory pathways leading to severe to profound hearing loss and often cannot be treated with medical interventions. Moreover, most of the children with congenital hearing loss affects hearing up to severe to profound degree. Therefore, hearing aids or cochlear implants will be a recommended form of treatment in these children depending on the type and severity of hearing loss. Some children with profound hearing impairment manage verbal communication skills through amplification devices like traditional hearing aids. However, some do not benefit from hearing aids and affect the development of speech and language skills. Failure to develop adequate speech and language skills can have a significant impact on the educational and employment opportunities of these individuals. However, hearing difficulties up to moderately severe degree can obtain good benefits from conventional hearing aids in most individuals. A cochlear implant is an electronic device that is placed into the inner ear through surgery and helps to replace the functions of inner ear such as cochlea. These cochlear implants stimulate the auditory nerve, thereby help in sound perception. These cochlear implants provide good benefits to both congenital as well as acquired hearing impaired children, who obtained limited benefits from hearing aids. * Benefits from Cochlear Implant Children using cochlear implants from younger age have shown better improvement in their auditory perception skills and sound detection abilities. Those children who used multichannel cochlear implants performed better than those of their non- implanted children who used hearing aids. These children who used multichannel cochlear implants have shown improvements in speech perception and speech production over a period of time. Research also have shown significant improvement in speech & language skills along with the improvement in overall speech intelligibility in children following cochlear implantation in congenital hearing impairment. However, large individual differences are reported in cochlear implant users due to the reasons such as age of onset of hearing loss, age at which cochlea implant is fitted, duration of cochlear implant usage, and the speech language training received. * Candidacy of cochlear implants Cochlear implantation is a team approach in which various professionals are involved such as ENT, Radiologist, Audiologist, Speech language pathologist and Auditory verbal therapist. In determination of cochlear implant suitability, precise assessment of hearing loss by an audiologist is a most important factor. The audiologist uses age-appropriate tests (behavioral and physiological measures) to determine the nature and the type of hearing loss. Bilateral severe-to-profound sensorineural hearing loss in pure tone audiogram, confirmed by acoustic reflex data with auditory brain stem response often determines the audiological candidacy for cochlear implantation. Then appropriate amplification devices and auditory verbal therapy training has to be done followed by repeated behavioral audiological test. Only after receiving sufficient training after hearing aid fitting, a cochlear implant candidacy is often indicated. Only those people who receive limited or no benefit from hearing aid and having congenital or acquired severe to profound sensorineural hearing loss are the candidates for cochlear implants. Candidates for cochlear implantation require medical evaluation by a ENT professional. The patient should be free from active ear diseases, have an intact ear drum, and should tolerate general anesthesia. CT or MRI scan, or both, may be necessary to identify the implantable ear. * Management of Children with Cochlear Implants Children who are fitted with cochlear implants require frequent consultation with Audiologist and ENT. Audiologists programs the cochlear implant parameters and monitors the device performance. Audiologists also monitor the improvement in speech perception following implantation. Medical evaluation by ENT professional should also be performed to monitor the medical condition of the child or an adult. Training is one of the important segments in children after cochlear implantation to maximize the benefits that they receive from it. Habilitation training should include development of listening behaviors within meaningful communicative contexts. Speech pathologists often interact with audiologists and enhances the benefits what they receive. We at Department of Audiology and Speech Language Pathology, Attavara, Kasturba Medical College, Mangalore is one of the premier institutions providing services not only related to speech and hearing disorders but also rendering services in developing human resource who can help these disordered population. At our center, we provide services in identification, assessment and rehabilitation related to speech and hearing disorder. Our center is identified as one of centers for implementation of ADIP scheme for cochlear implant under central government scheme. We have been actively involved in cochlear implantation since 2006 and now since 2016 under ADIP scheme. Under this scheme cochlear implantation and rehabilitation services are provided for free of cost by central government however candidacy assessment has to be borne by a cochlear implantee. At present, these services are available for children below 6 years and with family monthly income of less than Rs.15000 per month. We at our department have implemented this scheme successfully. We are also a part of State government cochlear implant team at Government Wenlock Hospital. Moreover, hearing aids under ADIP scheme are also available at District disability rehabilitation center at Government Wenlock hospital. So, consulting an Audiologist at the right time and early in life is the key to success in improving communication skills in patients with hearing impairment.