Of the following, the most likely adult candidate for a cochlear implant is one with a

• A. Bilateral hearing loss due to adult meningitis
• B. Bilateral hearing loss due to noise exposure
• C. Bilateral hearing loss due to chronic otitis media
• D. Unilateral hearing loss of sudden onset and unknown etiology

Answer: (A)

Cochlear implants are considered for adults who have severe to profound sensorineural hearing loss in both ears and have little or no benefit from appropriately fitted hearing aids. Among the scenarios given, bilateral loss from adult meningitis fits this profile most strongly. Meningitis often causes rapid, substantial damage to the inner ear structures, resulting in severe to profound bilateral hearing loss with poor speech recognition. Because the loss is profound and bilateral and amplification typically cannot restore meaningful speech understanding, a cochlear implant becomes a primary option to provide access to sound and improve communication.

The other scenarios don’t align as well with typical candidacy. Noise-induced loss can be severe but often patients retain some residual hearing or benefit from high-powered hearing aids, and cochlear implants are reserved for cases where amplification fails to provide useful benefit. Chronic otitis media usually presents with conductive (middle-ear) loss rather than a primarily cochlear (sensorineural) loss, so a cochlear implant is not the first-line solution unless a sensorineural component is present and amplification is ineffective. A unilateral, sudden-onset loss—even if the etiology is unknown—does not meet the bilateral criterion that often guides CI candidacy, since one normal-hearing ear can provide substantial auditory input.

So the scenario most consistent with a cochlear implant candidate in an adult is bilateral hearing loss due to meningitis.