Cochlear Implantation in Children with Labyrinthine Anomalies and Cochlear Nerve Deficiency: Implications for Auditory Brainstem Implantation
Cochlear Implantation in Children with Labyrinthine Anomalies and Cochlear Nerve Deficiency: Implications for Auditory Brainstem Implantation
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DOI：
10.1002/lary.22032
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发表时间：
2011-09-01
期刊：
影响因子：
2.6
通讯作者：
Adunka, Oliver F.
中科院分区：
文献类型：
--
作者：
Buchman, Craig A.;Teagle, Holly F. B.;Adunka, Oliver F.
目标/假设：比较内耳畸形和/或耳蜗神经缺陷（CND）儿童接受人工耳蜗植入（CI）的结局。研究设计：1993年至2010年的个体回顾性队列研究。对影像学特征、手术结果、并发症、标测参数和性能进行了评估。结果：手术大多不复杂。几乎所有的儿童表现出行为反应CI刺激，无论内耳形态或CND的存在。与其他畸形类型相比，患有CND的儿童具有更高的纯音平均值（PTA），并且需要更大的刺激电荷。开放式语音感知在不完全分隔扩大前庭水管（IP-EVA）的儿童中达到100%，在发育不良畸形的儿童中达到50%，在CND病例中达到19%。通过植入物测试第八神经复合动作电位（ECAP）的强烈反应与更高水平的言语感知相关。人工辅助沟通策略在发育不良畸形（69%）和CND（95%）儿童中比IP-EVA（18%）儿童更常见。结论：IP-EVA畸形儿童在CI后发展开放式言语感知和使用口头沟通模式具有良好的预后。相反，患有严重畸形或CND的儿童可能需要更高的电荷才能单独实现声音检测。这些儿童获得开放式言语理解、使用专用口语交流和参与主流教育的预后较为有限。这些研究结果有重要的意义，考虑替代形式的干预，如听觉脑干植入和/或补充视觉为基础的沟通策略。
Objectives/Hypothesis: Compare outcomes among children with inner ear malformations and/or cochlear nerve deficiency (CND) who have received a cochlear implant (CI).Study Design: Individual retrospective cohort study from 1993 to 2010.Methods: A select cohort of 76 children was identified. Imaging characteristics, operative findings, complications, mapping parameters, and performance were assessed. Comparisons among the different groups were undertaken.Results: Surgery was mostly uncomplicated. Nearly all children demonstrated behavioral responses to CI stimulation irrespective of inner ear morphology or the presence of CND. Children with CND had higher pure tone averages (PTAs) and required greater charge for stimulation than other malformation types. Open-set speech perception was achieved in 100% of children with incomplete partition-enlarged vestibular aqueduct (IP-EVA), 50% of those with hypoplastic malformations, and 19% of CND cases. Robust responses on eighth nerve compound action potential (ECAP) testing through the implant was associated with higher levels of speech perception. Manually supplemented communication strategies were more common among children with hypoplastic malformations (69%) and CND (95%) than those with IP-EVA (18%).Conclusions: Children with IP-EVA malformations have an excellent prognosis for developing open-set speech perception and using oral communication modes following CI. On the contrary, children with severe malformations or CND may have elevated charge requirements for attaining sound detection alone. These children's prognosis for obtaining open-set speech understanding, using exclusive oral communication, and participating in mainstream education is more limited. These findings have important implications for considering alternative forms of intervention such as auditory brainstem implantation and/or supplementation with visually based communication strategies.