Children with progressive sensorineural hearing impairment represent a special challenge to the audiologist and the otologist. These are patients with some residual auditory abilities that deteriorate with time as the hearing loss progresses. No doubt, the unnecessary implantation of an ear that significantly benefits from amplification needs to be avoided at all costs. By the same token however, there appears to be no advantage to waiting an inordinate amount of time after the loss of functional auditory abilities before recommending implantation. At times when a complete loss is predictable, implantation may be advantageous before the onset of complete auditory deprivation. Steps the clinicians should take to manage these patients effectively are briefly summarized below: Implementation of rigorous and frequent audiologic monitoring. If, for instance, a significant progressive loss of hearing has occurred over a 6-month period, resulting in a complete absence of open-set speech recognition abilities in the auditory-alone mode with appropriate hearing aids, it is probably counterproductive to wait to the point of a complete absence of aided speech detection. Implantation at a critical point in time will prevent complete auditory deprivation. Parental counseling concerning various management strategies, such as use of vibrotactile devices, changing communication skills, and issues involving cochlear implants need to be undertaken early. Parents need to be involved in every phase of the evaluation process because they are the ones who make the final decision concerning the implantation of their child. Relatively early implantation should be considered in light of what is known concerning the effects of disruption in a child's linguistic, cognitive, and emotional development resulting from complete auditory deprivation.(ABSTRACT TRUNCATED AT 250 WORDS)