Towards the development of a prognostic tool for cochlear implant outcome using functional near-infrared spectroscopy (fNIRS).

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Background: In the UK, four babies are born deaf each day. Children with hearing loss not only have delayed speech and language development, but also have lower educational achievements compared with children who have normal hearing. A cochlear implant is a device that can restore a sensation of hearing to children who are born or become deaf. All newborns are now tested for a hearing loss. Subsequently, children who are suitable for a cochlear implant can be identified in the first few days or months of life. Overall, speech understanding in children improves after cochlear implantation. However, some children's speech and language abilities are much worse than we would otherwise expect and we don't fully understand why this happens. The current tests for assessing levels of hearing and speech understanding are unreliable in very young children. Since children that are born deaf often receive their cochlear implants within the first year or two of life, years can often pass before parents and healthcare professionals become aware of poor speech and language skills. Currently, it is extremely difficult to distinguish between very young children with cochlear implants who are performing well and those who are performing not so well. We want to understand why some children can hear well with a cochlear implant and others cannot. We would also like to predict and identify at the earliest possible stage those children with a cochlear implant who have poor speech understanding. Aims of this research: At the Nottingham Hearing Biomedical Research Centre, we propose to use a non-invasive brain scanning method called functional near-infrared spectroscopy, or fNIRS for short, to measure brain activity in deaf children before and immediately after they receive a cochlear implant. We want to know if this brain scanning technique can be used to test how well a child can hear and understand speech instead of having to rely on existing hearing tests that are only suitable for older children. Although we have considered other methods for measuring brain activity, they are either not safe for use in patients with a cochlear implant or are associated with potential harmful effects. fNIRS is completely safe for children both before and after cochlear implantation and does not have any side effects or risks to health.Expected benefits of this research: If we are able to assess how well a child can hear using fNIRS, clinical professionals could measure speech abilities in much younger children than is presently possible. Subsequently, we will be able to identify and treat children who are not hearing so well at the earliest age. In so doing, we will identify those children with a cochlear implant who struggle with their hearing and need extra speech and language support. At present, without any idea of the abilities of our very young children with cochlear implants, valuable NHS resources for speech and language support are provided to every single child, so that some children may receive more support than they require, whilst others receive too little. fNIRS may help us to tailor and more appropriately direct speech and language support to those children who need it the most. We would also be able to give parents a more accurate explanation of how likely their child is to improve with their cochlear implant. Cochlear implants also need to be 'fine tuned' or programmed regularly so that they provide the best possible level of hearing to meet the needs of an individual. fNIRS has the potential to guide and improve this programming process. This is because it may be able to inform us on how well speech and sound is understood by the brain, years before a child is old enough to tell us, and enable us to make the appropriate adjustments to their cochlear implant. We believe that fNIRS has the potential to allow every child with a cochlear implant to have the best possible treatment that is tailored to their individual needs.