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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Cochlear implantation in children with anomalous cochleovestibular anatomy: a systematic review
Michael N Pakdaman1, Barbara S Herrmann, Hugh D Curtin
1Department of Otorhinolaryngology, University of Texas Medical School, Houston, Texas, USA.
Insights
Severe inner ear dysplasia complicates pediatric cochlear implant (CI) surgery, potentially lowering speech perception. More standardized reporting is needed to confirm these findings for anomalous cochleovestibular anatomy.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neurosurgery
Background:
- Inner ear dysplasia presents unique challenges in pediatric cochlear implantation.
- Understanding its impact on surgical and hearing outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the influence of inner ear dysplasia on surgical and audiologic outcomes in children undergoing cochlear implant (CI) surgery.
Main Methods:
- Systematic literature review (1982-2009) and analysis of institutional data.
- Included 311 patients, assessing age, CI duration, radiologic/operative findings, and speech perception.
- Common anomaly: large vestibular aqueduct (29%).
Main Results:
- Severe dysplasia correlated with higher rates of anomalous facial nerve anatomy (51% vs. 11%) and lower speech perception (54% vs. 84%).
- Cerebrospinal fluid gusher rates were similar between mild-moderate and severe dysplasia groups (31% vs. 35%).
- Significant heterogeneity across studies limited definitive conclusions.
Conclusions:
- Severe inner ear dysplasia is linked to increased surgical complexity and reduced speech perception.
- Inconsistent reporting and testing methods hinder definitive conclusions.
- Standardized reporting and speech perception assessments are necessary to clarify the relationship between cochleovestibular anomalies and clinical outcomes.
Objective:
To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery.
Data Sources:
MEDLINE (1982-2009) and data from Massachusetts Eye and Ear Infirmary.
Review Methods:
A systematic review of the literature was performed. Variables assessed included age at implantation, duration of CI use, radiologic and operative findings, and speech perception outcome data.
Results:
The initial search yielded 1326 articles. Including data from our own study, twenty-two fulfilled criteria for inclusion, representing 311 patients. Data for bilateral implants were recorded only for the first implant. Data on simultaneous bilateral implants were not recorded. The most common anomaly seen was large vestibular aqueduct (89/311 or 29%). When comparing patients with mild-moderate or severe dysplasia, rates of cerebrospinal fluid gusher were 31% versus 35% (odds ratio [OR] = 0.50), anomalous facial nerve anatomy was seen in 11% versus 51% (OR = 0.15), and postoperative speech perception abilities were found in 84% versus 54% (OR = 1.93), respectively. A large heterogeneity was found among studies regarding all outcome measures.
Conclusion:
Although we found that severe inner ear dysplasia was associated with increased surgical difficulty and lower speech perception, the lack of uniformity in published clinical data limited the strength of these results. Standardization of surgical and radiologic reporting as well as more consistent speech perception testing is needed to better determine the association between anomalous cochleovestibular anatomy and clinical outcomes.
Related Concept Videos
01:13The Cochlea
01:29The Vestibular System