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Published on: October 11, 2024
Residual hearing preservation after pediatric cochlear implantation
Ryan F Brown1, Timothy E Hullar, Jamie H Cadieux
1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Insights
Preserving residual hearing in pediatric cochlear implant patients is feasible with standard electrode arrays. This study shows high rates of hearing preservation, offering hope for children with progressive hearing loss.
Area of Science:
- Otolaryngology
- Audiology
- Neurosurgery
Background:
- Pediatric cochlear implantation aims to restore hearing in severe to profound hearing loss.
- Maintaining residual hearing is crucial for speech perception and language development in children.
- Standard electrode arrays are commonly used, but their impact on hearing preservation requires further investigation.
Purpose of the Study:
- To evaluate the feasibility of preserving residual hearing in pediatric patients undergoing cochlear implantation using standard electrode arrays.
- To assess hearing preservation rates and functional hearing outcomes after cochlear implantation.
- To describe the surgical technique employed for cochlear implantation.
Main Methods:
- Retrospective review of medical records from 31 pediatric patients with residual hearing.
- Cochlear implantation performed using a modified "soft surgery" protocol with full-length standard electrode arrays.
- Pre- and post-operative audiograms analyzed to calculate pure tone thresholds and hearing preservation rates.
Main Results:
- Complete hearing preservation (≤10 dB loss) was achieved in 45.2% of patients.
- 90.3% of patients demonstrated at least partial hearing preservation (≤40 dB loss).
- 50% of patients with preoperative functional hearing maintained it postoperatively.
Conclusions:
- Standard-length electrode arrays with full insertions are effective for preserving residual hearing in pediatric cochlear implant recipients.
- These findings are significant for managing pediatric patients at risk of progressive hearing loss.
- The described surgical technique supports successful hearing preservation outcomes.
Objective:
This study is designed to test the hypothesis that preservation of residual hearing in a pediatric population is possible using standard electrode arrays with full-length insertions. Surgical technique during implantation also is described.
Study Design:
Retrospective review of patient medical records.
Setting:
Academic tertiary care center.
Patients:
Thirty-one severely to profoundly hearing impaired pediatric patients with some residual hearing precochlear implantation.
Intervention:
Cochlear implantation using a modified "soft surgery" protocol.
Main Outcome Measures:
Preimplant and postimplant pure tone thresholds and pure-tone average were calculated from unaided preoperative and postoperative audiograms from 250, 500, and 1,000 Hz. Hearing preservation rates were determined to be complete (loss of ≤10 dB), moderate (loss of 11-20 dB), marginal (loss of 21-40 dB), or none (loss of >40 dB or no response at the limits of the audiometer). Functional residual hearing rates (defined in this study as at least 1 threshold better than or equal to 75 dB HL for 250, 500, or 1,000 Hz were calculated.
Results:
Complete hearing preservation was achieved in 14 (45.2%) of 31 patients, whereas 28 (90.3%) of 31 had at least partial hearing preservation (loss of ≤40 dB). The preoperative to postoperative low-frequency pure-tone average had a mean change of 18.5 dB and median change of 20 dB. Of the patients who had preoperative functional hearing, 9 (50.0%) of 18 maintained functional residual hearing postoperatively for at least 1 pitch.
Conclusion:
Preservation of residual hearing is feasible in pediatric cochlear implant patients using standard-length electrode arrays with full insertions. These data have implications for cochlear implantation in pediatric patients who are at higher risk of progressive hearing loss than adults.