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The prognostic value of promontory electric auditory brain stem response in pediatric cochlear implantation
T P Nikolopoulos1, S M Mason, K P Gibbin
1Department of Otolaryngology, University Hospital, Queen's Medical Center NHS Trust, Nottingham, United Kingdom.
Insights
Children without clear promontory electrically evoked auditory brain stem responses (prom-EABRs) before cochlear implantation performed comparably to those with clear responses. The prognostic value of prom-EABRs is limited for cochlear implant outcomes.
Area of Science:
- Otolaryngology
- Neuroscience
- Pediatric audiology
Background:
- Auditory Brainstem Responses (ABRs) assess the auditory pathway's integrity.
- Promontory electrically evoked ABRs (prom-EABRs) are used to evaluate cochlear nerve function in potential cochlear implant candidates.
Purpose of the Study:
- To determine if children with clear preoperative prom-EABRs outperform those without after cochlear implantation.
- To assess the prognostic value of prom-EABRs for post-implantation auditory outcomes.
Main Methods:
- Prospective study of 47 children undergoing cochlear implantation, divided into groups based on preoperative prom-EABR presence.
- Speech perception and intelligibility assessed annually for 3 years using standardized tests.
- Statistical analysis (t-test, Mann-Whitney U) compared outcomes between groups.
Main Results:
- No statistically significant differences in speech perception or intelligibility were found between children with and without preoperative prom-EABRs.
- Observed minor differences showed no consistent trend favoring either group.
- Outcomes were not significantly affected by confounding factors like age, duration of deafness, or device specifics.
Conclusions:
- Absence of a preoperative prom-EABR does not contraindicate cochlear implantation.
- Prom-EABRs have limited prognostic value for post-implantation auditory performance in children.
- Presence of prom-EABRs is a positive indicator of intact auditory neurons in specific cases, aiding candidate assessment.
Objective:
To test the hypothesis that children with clear promontory electrically evoked auditory brain stem responses (prom-EABRs) would outperform, after cochlear implantation, children who had no prom-EABR preoperatively.
Design:
A prospective study was undertaken on 47 implanted children assigning them to two groups (group A: 35 children with a clear wave e-V in the preoperative prom-EABR and group B: 12 children with no prom-EABR). Speech perception and speech intelligibility were assessed annually up to 3 yr after implantation with the IOWA sentence test (level A and level B), Connected Discourse Tracking, Categories of Auditory Performance, and Speech Intelligibility Rating. t-test and Mann-Whitney U test were used to compare the above outcome measures in the two groups.
Results:
There was no statistically significant difference between the two groups on any of the outcome measures at any interval. Moreover, the small differences observed showed no consistent trend toward either group of children. Further analysis revealed that the outcomes have not been affected by possible confounding factors (age at implantation, duration of deafness, preoperative unaided pure-tone thresholds, and number of inserted electrodes).
Conclusions:
The results suggest that children with no prom-EABR performed at levels comparable with children who had clear promontory responses preoperatively. The prognostic value of prom-EABR is limited and absence of a prom-EABR is not, by itself, a contraindication for cochlear implantation. However, in selected cases (congenital malformations, cochlear nerve dysplasia or suspected aplasia, narrow internal auditory canal, etc.) the presence of a prom-EABR is a positive finding in the assessment of candidates for cochlear implantation as it confirms the existence of intact auditory neurones.