fMRI, Genes and Outcome for Cochlear Implants in Infants

描述（由申请人提供）：耳蜗植入（CI）彻底改变了先天性耳聋儿童的管理。[1]越来越多的证据表明，尽早对先天性耳聋的婴幼儿进行人工耳蜗植入可以获得最好的结果。[2，3]然而，婴儿的听觉感知和语言技能很难准确评估。[4]目前在38个州实施的新生儿听力筛查计划预计每天将在全国范围内识别出30-40名先天性听力损失儿童，[6][7]这就迫切需要评估和管理策略，利用12-18个月大的早期干预机会窗口（如CI）。 功能性磁共振成像（fMRI），提供了一个新的工具，评估中枢听觉过程的婴儿。[8-10] fMRI是非侵入性的，即使对婴儿也没有已知的生物学风险。[11]功能磁共振成像可以区分正常和听力受损婴儿的听觉检测，言语感知和语言处理的大脑反应。[12]功能磁共振成像能够显示婴儿和幼儿的各种听觉和语言处理水平，可以为临床医生提供重要的数据，这些数据在语前婴儿中无法通过任何其他手段获得。 目前的建议是为了确定是否（H2）植入前皮层激活模式所揭示的fMRI在婴儿期将与听觉性能两年后人工耳蜗植入和（H1）fMRI是否可以揭示临床相关的细节中枢听觉系统在婴儿期。三个具体的目标是为了测试这些假设。我们计划（S1）在临床3 T MRI系统上优化无声背景、听觉刺激fMRI方法;（S2）获得听力正常（n=30）和听力受损（n=60）婴儿的fMRI和听力测试数据;（S3）将1岁时听力受损婴儿的fMRI显示的中枢听觉激活模式与人工耳蜗植入后2年的结果测量相关联。我们希望这项研究的成功完成将为临床医生提供一种新的工具，以指导听力受损婴儿的最佳干预策略。

DESCRIPTION (provided by applicant): Cochlear implantation (CI) has revolutionized the management of congenitally deaf children.[1] A growing body of evidence suggests that that performing CI as early as possible in congenitally deaf infants and toddlers results in the best outcome.[2, 3] However, auditory perception and language skills are difficult to assess accurately in infants.[4] Newborn hearing screening programs now in place in 38 states, are expected to identify 30-40 children per day nationally with congenital hearing loss, [6][7] precipitating the need for assessment and management strategies that utilize early windows of opportunity for interventions (such as a CI) by 12-18 months of age. Functional magnetic resonance imaging (fMRI), offers a novel tool for evaluation of central auditory processes in infants.[8-10] fMRI is non-invasive and presents no known biological risks, even for infants.[11] fMRI may permit differentiation of brain responses corresponding to auditory detection, speech perception and language processing in normal and hearing-impaired infants.[12] The ability of fMRI to demonstrate various levels of auditory and language processing in infants and toddlers can provide important data to clinicians that is not available by any other means in prelingual babies. The current proposal is designed to ascertain whether (H2) pre-implant cortical activation patterns revealed by fMRI during infancy will correlate with auditory performance two years after cochlear implantation and whether (H1)fMRI can reveal clinically relevant details about the central auditory system in infancy. Three specific aims are designed to test these hypotheses. We plan to (S1) optimize a silent background, auditory stimulation fMRI method on a clinical 3T MRI system, (S2) acquire fMRI and hearing test data on normal hearing (n=30) and hearing impaired infants (n=60) and (S3) correlate central auditory activation pattems revealed by fMRI in hearing impaired infants at 1 year of age, with outcome measures 2 years after cochlear implantation. Our hope is that successful completion of the proposed study will provide clinicians with a new tool to guide optimal intervention strategies for hearing-impaired infants.