RESUMEN
Studies have demonstrated the benefits of low frequency residual hearing in music perception and for psychoacoustic abilities of adult cochlear implant (CI) users, but less is known about these effects in the pediatric group. Understanding the contribution of combined electric and acoustic stimulation in this group can help to gain a better perspective on decisions regarding bilateral implantation. We evaluated the performance of six unilaterally implanted children between 9 and 13 years of age with contralateral residual hearing using the Clinical Assessment of Music Perception (CAMP), spectral ripple discrimination (SRD), and temporal modulation transfer function (TMTF) tests and compared findings with previous research. Our study sample performed similarly to normal hearing subjects in pitch direction discrimination (0.81 semitones) and performed well above typical CI users in melody recognition (43.37%). The performance difference was less in timbre recognition (48.61%), SRD (1.47 ripple/octave), and TMTF for four modulation frequencies. These findings suggest that the combination of low frequency acoustic hearing with the broader frequency range of electric hearing can help to increase clinical CI benefit in pediatric users and decisions regarding second-side implantation should consider these factors.
RESUMEN
BACKGROUND: Children with steeply sloping sensorineural hearing loss (SNHL) lack access to critical high-frequency cues despite the use of advanced hearing aid technology. In addition, their auditory-only aided speech perception abilities often meet Food and Drug Administration criteria for cochlear implantation. PURPOSE: The objective of this study was to describe hearing preservation and speech perception outcomes in a group of young children with steeply sloping SNHL who received a cochlear implant (CI). RESEARCH DESIGN: Retrospective case series. STUDY SAMPLE: Eight children with steeply sloping postlingual progressive SNHL who received a unilateral traditional CI at Seattle Children's Hospital between 2009 and 2013 and had follow-up data available up to 24 mo postimplant were included. DATA COLLECTION AND ANALYSIS: A retrospective chart review was completed. Medical records were reviewed for demographic information, preoperative and postoperative behavioral hearing thresholds, and speech perception scores. Paired t tests were used to analyze speech perception data. Hearing preservation results are reported. RESULTS: Rapid improvement of speech perception scores was observed within the first month postimplant for all participants. Mean monosyllabic word scores were 76% and mean phoneme scores were 86.7% at 1-mo postactivation compared to mean preimplant scores of 19.5% and 31.0%, respectively. Hearing preservation was observed in five participants out to 24-mo postactivation. Two participants lost hearing in both the implanted and unimplanted ear, and received a sequential bilateral CI in the other ear after progression of the hearing loss. One participant had a total loss of hearing in only the implanted ear. Results reported in this article are from the ear implanted first. Bilateral outcomes are not reported. CONCLUSIONS: CIs provided benefit for children with steeply sloping bilateral hearing loss for whom hearing aids did not provide adequate auditory access. In our cohort, significant improvements in speech understanding occurred rapidly postactivation. Preservation of residual hearing in children with a traditional CI electrode is possible.
Asunto(s)
Implantes Cocleares , Pérdida Auditiva de Alta Frecuencia/rehabilitación , Pérdida Auditiva Sensorineural/rehabilitación , Percepción del Habla/fisiología , Audiometría de Tonos Puros , Umbral Auditivo/fisiología , Preescolar , Implantación Coclear , Femenino , Audición/fisiología , Audífonos , Pérdida Auditiva de Alta Frecuencia/psicología , Pérdida Auditiva de Alta Frecuencia/cirugía , Pérdida Auditiva Sensorineural/psicología , Pérdida Auditiva Sensorineural/cirugía , Humanos , Masculino , Cuidados Posoperatorios , Cuidados Preoperatorios , Reconocimiento en Psicología/fisiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: To describe patterns of hearing loss in patients with low-frequency residual hearing after cochlear implantation. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Cochlear implant candidates with immediate postoperative residual low-frequency hearing. INTERVENTIONS: Hybrid or traditional cochlear implant. MAIN OUTCOME MEASURE: Audiograms to measure postoperative hearing. RESULTS: Of the 166 patients reviewed, 17 ears met the inclusion criteria. The age ranged from 3 years 2 months to 86 years. Etiology was unknown (nâ=â6), presbycusis (nâ=â5), genetic (nâ=â4), acoustic trauma (nâ=â1), and measles virus (nâ=â1). The Nucleus Hybrid S8 and S12 (nâ=â7) was the most common electrode array, and then Nucleus 422 (nâ=â6), Nucleus Contour Advance (nâ=â2), Med-El Flex 28 (nâ=â2), and Advanced Bionics Mid Scala (nâ=â1). Cochleostomy was performed in nine, and round window approach in nine patients. Average follow-up was 28 months (2-68 mo). Postoperative loss was mixed in eight and purely sensorineural in eight. The most common patterns of hearing loss were gradual decline (nâ=â7), and then fluctuating hearing (nâ=â6), stable (nâ=â3), and sudden loss (nâ=â1). One patient only had one postoperative audiogram. CONCLUSION: Some long-term hearing preservation was achieved in 94% of patients with immediate postoperative hearing preservation. Patients developed both mixed and sensorineural loss postoperatively. A majority of patients with mixed hearing loss had a supra-preoperative bone curve. Gradual decline and fluctuating hearing loss were the most common patterns of hearing loss; few patients had stable hearing and one had a sudden loss.