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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
Factors that influence performance in pediatric cochlear implant recipients with cochlear nerve deficiency
Nicholas J Thompson1, Lisa R Park1, Brendan P O'Connell2
1Department of Otolaryngology/Head & Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Children with cochlear nerve deficiency (CND) can benefit from cochlear implants (CI). Cochlear nerve hypoplasia and lack of cognitive delay predict better outcomes for pediatric CI recipients.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neurosurgery
Background:
- Cochlear nerve deficiency (CND) presents variable outcomes in pediatric cochlear implant (CI) recipients.
- Identifying predictors of CI success in this population is crucial for management.
Purpose of the Study:
- To report outcomes from a large cohort of pediatric CI recipients with CND.
- To identify factors predicting improved postoperative performance in these children.
Main Methods:
- Retrospective review of 47 pediatric CI recipients with CND.
- Analysis of cochlear nerve status (hypoplasia vs. aplasia), age, malformations, and cognitive delay.
- Stepwise multinomial regression to determine performance predictors.
Main Results:
- 59% demonstrated auditory capabilities with CI; 20% achieved open-set speech perception.
- Cochlear nerve hypoplasia correlated with significantly better outcomes than aplasia (p=0.003).
- Cognitive delay was associated with more limited CI benefit (p=0.033).
Conclusions:
- Pediatric CI recipients with CND can achieve a range of auditory and speech benefits.
- Cochlear nerve hypoplasia and absence of cognitive delay are positive prognostic indicators.
- Findings aid in counseling families and guiding treatment decisions for CND.
Objectives:
Children with cochlear nerve deficiency (CND) have wide variability in outcomes with cochlear implant (CI) use. The current study aims to report a large cohort of pediatric CI recipients with CND and to evaluate for factors that may predict improved performance.
Methods:
The current study is a retrospective review of pediatric CI recipients with CND at a tertiary academic hospital. Variables including cochlear nerve status (hypoplasia vs aplasia), age at implantation, cochleovestibular malformation, bony cochlear nerve aperture, internal auditory canal aperture, and cognitive delay were evaluated for predictors of postoperative performance. A stepwise multinomial regression analysis was performed.
Results:
Forty-seven CI recipients (54 ears) were included in the analysis. A majority (59%) showed auditory capabilities with their CI. Twenty percent of recipients achieved some level of open-set speech perception with their CI. The regression analysis identified cochlear nerve status and cognitive delay as predictors of performance. CI recipients with cochlear nerve hypoplasia had significantly improved performance compared to those with aplasia (p = 0.003). Recipients with cognitive delay had more limited benefit than those without cognitive delay (p = 0.033).
Conclusions:
Children with CND can benefit from CI use, with outcomes spanning from non-use to development of spoken language. Predictive factors for improved performance include a lack of cognitive delay and cochlear hypoplasia rather than aplasia. These can be important considerations for parent counseling and decision making.
