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Bilateral cochlear implantation in children with anomalous cochleovestibular anatomy
Neil K Chadha1, Adrian L James, Karen A Gordon
1Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada. neil.chadha@utoronto.ca
Insights
Bilateral cochlear implantation is safe and effective for children with inner ear anomalies, leading to successful hearing outcomes. These findings support broader candidacy for implantation in pediatric patients with cochleovestibular malformations.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neurosurgery
Background:
- Congenital inner ear malformations present unique challenges for hearing restoration.
- Bilateral cochlear implantation (BCI) is increasingly common, but data in anomalous cochleovestibular anatomy are limited.
Purpose of the Study:
- To evaluate the safety and efficacy of BCI in pediatric patients with cochleovestibular anomalies.
- To provide insights into surgical techniques and candidacy for this specific population.
Main Methods:
- Prospective cohort study of 10 children (9-33 months) with congenital inner ear malformations.
- Sequential or simultaneous BCI with a mean follow-up of 12 months.
- Assessment of complications, hearing, and balance outcomes.
Main Results:
- Successful implantation in all participants with no major complications.
- Five children experienced a perilymph
- gusher
- (unilateral).
- All achieved speech reception, with excellent performance in closed-set (100%) and open-set (71%) speech perception tests.
- Transient unsteadiness occurred in 30% but resolved within 2 weeks.
Conclusions:
- BCI is a safe and successful surgical option for children with diverse cochleovestibular anomalies.
- Hearing outcomes support including these children in BCI candidacy.
- The study offers guidance on surgical decision-making and techniques for this patient group.
Objective:
To outline clinical experience with bilateral cochlear implantation in children with cochleovestibular anomalies.
Design:
A prospective cohort study with a mean follow-up of 12 months.
Setting:
An academic, pediatric, tertiary referral center.
Patients:
All eligible children were prospectively recruited from January 1, 2007, through October 31, 2008. Ten children aged 9 to 33 months who had congenital inner ear malformations, including common cavity, incomplete partition, and cochleovestibular hypoplasia, participated.
Interventions:
Bilateral cochlear implantation was performed sequentially with an interimplantation delay greater than 2 years in 7 children and less than 1 year in 1 child. Bilateral simultaneous implantation was performed in 2 children.
Main Outcome Measures:
Complications, hearing outcomes, and balance outcomes.
Results:
All children underwent successful implantation. Five children had a perilymph "gusher" (on 1 side only), and there were no other complications. All children had 22 active electrodes bilaterally and achieved speech reception. All 8 children who underwent closed-set speech perception testing scored above 75%, and 5 of the 7 children who underwent open-set testing achieved scores above 75%. Despite variable vestibular function before bilateral implantation, no prolonged imbalance occurred, although 3 children (30%) had transient unsteadiness for up to 2 weeks after the second implantation.
Conclusions:
Bilateral cochlear implantation was performed safely and successfully in children with a spectrum of bilaterally anomalous cochleovestibular anatomy. Hearing outcomes suggest that these children should not be excluded from undergoing bilateral implantation. This study provides guidance on candidacy issues, surgical decision making, and surgical techniques in this group.
