Speech Perception Outcomes Research Articles

Large vestibular aqueduct syndrome: Impedance changes over time with different cochlear implant electrode arrays

ObjectivesThe aim of this study was to assess if large vestibular aqueduct syndrome (LVAS), with the increase in perilymphatic pressure, affects impedance changes over time with different types of Cochlear® implant electrode arrays Contour, Straight, and CI 422. To report speech perception outcomes for these cochlear implant recipients.MethodsRetrospective case review of impedance levels and categories of auditory performance. Impedance data were collected at switch on, 1 month, 3, 6, 12, and 24 months after cochlear implantation and compared with control (non-LVAS cochlear implant recipient) data for each array type. Forty-seven patients with exclusive LVAS and no other vestibulocochlear abnormalities or other identifiable cause of deafness were eligible for inclusion in the study.ResultsIn LVAS patients, there was a significant difference in impedance between the three types of device (P < 0.0001). Time since switch on was associated with a decrease in impedance for all three devices (P < 0.0001). The mean impedance reduced between switch on and 1 month and remained relatively constant thereafter. Sound variation with softening of sounds was seen in four CI 422 (Straight Research Array) recipients due to ongoing fluctuations in electrode compliance.DiscussionFor all three array types, there was no significant difference in the mean impedance between the LVAS patients and controls over the first 12 months. In keeping with previous studies cochlear implant recipients with LVAS hear very well through the cochlear implant.

The Influence of Cochlear Implant Electrode Position on Performance

Objectives: To study the relation between variables related to cochlear implant electrode position and speech perception performance scores in a large patient population. Design: The study sample consisted of 203 patients implanted with a CII or HiRes90K implant with a HiFocus 1 or 1J electrode of Advanced Bionics. Phoneme and word score averages for the 1- and 2-year follow-up were calculated for 41 prelingually deaf and 162 postlingually deaf patients. Analyses to reveal correlations between these performance outcomes and 6 position-related variables (angle of most basal electrode contact, surgical insertion angle, surgical insertion, wrapping factor, angular insertion depth, linear insertion depth) were executed. The scalar location, as an indication for the presence of intracochlear trauma, and modiolus proximity beyond the basal turn were not evaluated in this study. In addition, different patient-specific variables (age at implantation, age at onset of hearing loss, duration of deafness, preoperative phoneme and word scores) were tested for correlation with performance. Results: The performance scores of prelingual patients were correlated with age at onset of hearing loss, duration of deafness and preoperative scores. For the postlingual patients, performance showed correlations with all 5 patient-specific variables. None of the 6 position-related variables influenced speech perception in cochlear implant patients. Conclusions: Although several patient-specific variables showed correlations with speech perception outcomes, not one of the studied angular and linear position-related variables turned out to have a demonstrable influence on performance.

Surgical findings and auditory performance after cochlear implant revision surgery.

The objective of this study was to review cochlear reimplantation outcomes in the tertiary hospital and analyze whether facts such as type of failure, surgical findings, or etiology of deafness have an influence. A retrospective study including 38 patients who underwent cochlear implant revision surgery in a tertiary center is performed. Auditory outcomes (pure tone audiometry, % disyllabic words) along with etiology of deafness, type of complication, issues with insertion, and cochlear findings are included. Complication rate is 2.7 %. Technical failure rate is 57.9 % (50 % hard failure and 50 % soft failure), and medical failure (device infection or extrusion, migration, wound, or flap complication) is seen in 42.1 % of the cases. Management of cochlear implant complications and revision surgery is increasing due to a growing number of implantees. Cases that require explantation and reimplantation of the cochlear implant are safe procedures, where the depth of insertion and speech perception results are equal or higher in most cases. Nevertheless, there must be an increasing effort on using minimally traumatic electrode arrays and surgical techniques to improve currently obtained results.

Outcomes after cochlear reimplantation in children

ObjectivesWith cochlear implantation now a routine procedure, reimplantation is becoming more commonplace for medical/surgical complications or device malfunctions. This study investigated the indications for reimplantation and the auditory outcomes following reimplantation surgery in prelingually-deafened children. MethodsOf the 539 prelingually deafened children implanted between 1990 and 2013, 45 were reimplanted (8.3% of implantations). Causes of reimplantation, type of device and angle of insertion at initial implantation were recorded, as well as type of implant reinserted, number of electrodes inserted and angle of insertion (calculated on cone beam computed tomography) on reimplantation, and finally any surgical findings. Speech perception test scores (phonetically balanced kindergarten (PBK) words, open-set sentence testing in quiet and in noise (S/N+ 10dB SNR), and speech tracking scores) were obtained 1, 2 and 3 years after reimplantation, and compared against the best speech recognition score obtained with the first implant before failure. ResultsMedical reasons for reimplantation were found in 10 cases (22.2%). A malfunctioning device had occurred in 35 cases (77.7%) including hard failure in 24 and soft failure in 11.Complete insertion was achieved in the scala tympani in 42 cases and in the scala vestibuli in one case; partial insertion occurred in the remaining two cases. In two cases, one or two electrode rings snatched off from the electrode array during removal. The mean insertion angle was 330.5° before surgery and 311.8° after reimplantation (no statistical difference p=0.48).The postoperative speech perception outcome measures showed no significant difference to the best score before reimplantation. Angle of insertion, type of device and etiology of deafness did not influence the results. The PBK performance improved over 10% in 43.2% of children, was similar in 40.5%, and showed a more than 10% decrease in 16.2% of children after reimplantation. The latter decline in performance was explained for some children by a partial insertion. ConclusionsReimplantation has no negative effect on auditory outcome. In rare cases, speech perception outcome may not improve, requiring a specific rehabilitation program.

Pediatric cochlear implantation: Role of language, income, and ethnicity

ObjectiveTo compare post-cochlear implantation (CI) early speech perception (ESP) outcomes between a non-English speaking, ethnic minority study group and an English speaking, ethnic majority control group. Study design/methodsWe performed a retrospective case-control study at an academic tertiary care children's hospital. Records were reviewed of 49 children who underwent CI from February 2005 to September 2011. Children with abnormal cognitive function (n=12), post-surgical complications (n=1), or incomplete SP testing (n=24) were excluded. The remaining 12 cases (mean implant age 4.3y) were reviewed for language, income, ethnicity, and ESP scores. Their scores were compared to a subset of patients (n=18; mean implant age 2.2y) serving as control from the Childhood Development after Cochlear Implantation (CDaCI) study at 1 year follow up where standard ESP testing was performed. Briefly, CDaCI includes a demographically balanced and multicenter-based pediatric cohort from which publications are beginning to define normative post-CI SP outcomes. ResultsOf our 12 children, 7 were Hispanic, 2 Caucasian, 2 multi-ethnicity and 1 Russian. 4 were non-English speaking, 5 spoke English as a second language, and 7 were bilingual. Three received bilateral CI. Mean early speech perception (ESP) scores (reported on a scale of 1–4) collected at 6 and 12 months in the study group were 1.71 and 1.75, respectively; in the control group, 3.83 and 3.92. At both follow up intervals the study group performed significantly worse than the control group (6mo P=0.048, 12mo P=0.01). ConclusionsThis study suggests that among pediatric CI recipients, those from predominantly non-English speaking, socioeconomically disadvantaged backgrounds develop SP at slower than normal rates. Future interventions should be directed at overcoming these obstacles.

Intraoperative round window electrocochleography and speech perception outcomes in pediatric cochlear implant recipients.

The goal was to measure the magnitude of cochlear responses to sound in pediatric cochlear implant recipients at the time of implantation and to correlate this magnitude with subsequent speech perception outcomes. A longitudinal cohort study of pediatric cochlear implant recipients was undertaken. Intraoperative electrocochleographic (ECoG) recordings were obtained from the round window in response to a frequency series at 90 dB nHL in 77 children totaling 89 ears (12 were second side surgeries) just before device insertion. The increase in intraoperative time was approximately 10 min. An ECoG "total response" metric was derived from the summed magnitudes of significant responses to the first, second, and third harmonics across a series of frequencies. A subset of these children reached at least 9 months of implant use and were old enough for the phonetically balanced kindergarten (PB-k) word test to be administered (n = 26 subjects and 28 ears). PB-k scores were compared to the ECoG total response and other biologic and audiologic variables using univariate and multiple linear regression analyses. ECoG responses were measurable in almost all ears (87 of 89). The range of ECoG total response covered about 60 dB (from ~0.05 to 50 μV). Analyzing individual ECoG recordings in bilaterally implanted children revealed poor concordance between the measured response in the first versus second ear implanted (r = 0.21; p = 0.13; n = 12). In a univariate linear regression, the ECoG total response was significantly correlated with PB-k scores in the subset of 26 subjects who were able to be tested and accounted for 32% of the variance (p = 0.002, n = 28). Preoperative pure-tone average (PTA) accounted for slightly more of the variance (r = 0.37, p = 0.001). However, ECoG total response and PTA were significantly but only weakly correlated (r = 0.14, p = 0.001). Other significant predictors of speech performance included hearing stability (stable versus progressive) and age at testing (22 and 16% of the variance, respectively). In multivariate analyses with these four factors, the ECoG accounted for the most weight (β = 0.36), followed by PTA (β = 0.26). In a hierarchical multiple regression analysis, the most parsimonious models that best predicted speech perception outcomes included three variables: ECoG total response, and any two of preoperative PTA, age at testing, or hearing stability. The various three factor models each predicted approximately 50% of the variance in word scores. Without the ECoG total response, the other three factors predicted 36% of variance. Intraoperative round window ECoG recordings are reliably and easily obtained in pediatric cochlear implant recipients. The ECoG total response is significantly correlated with speech perception outcomes in pediatric implant recipients and can account for a comparable or greater proportion of variance in speech perception than other bio-audiologic factors. Intraoperative recordings can potentially provide useful prognostic information about acquisition of open set speech perception in implanted children.

Influence of age at revision cochlear implantation on speech perception outcomes.

This study reviewed whether advanced age should be a consideration when revision cochlear implantation is warranted. To examine whether age at revision cochlear implantation is related to postrevision speech perception performance. A retrospective analysis was performed in an academic tertiary care center. Participants included 14 younger adults (<65 years) and 15 older adults (≥65 years) who underwent revision cochlear implantation. Revision cochlear implantation. Speech perception performance, as measured with consonant-nucleus-consonant [CNC] words in quiet, at the best prerevision interval as well as the 3- and 6-month postrevision intervals were compared between the 2 cohorts. The CNC word test consists of 10 lists of 50 phonemically balanced monosyllabic words, scored with a range of 0% to 100% correct. Both cohorts experienced a restoration in speech perception scores after revision cochlear implantation compared with their best performance before the revision (mean [SD] CNC word test scores for the younger cohort: 43.9% [25.6%] before revision and 47.7% [21.3%] at 3 months and 47.6% [19.8%] at 6 months after revision; for the older cohort: 36.3% [19.1%] before revision and 35.3% [17.2%] at 3 months and 39.9% [16.3%] at 6 months after revision; F₂,₅₄= 0.93; P = .40). There was no interaction between age at revision surgery and speech perception performance at each assessment interval (F₂,₅₄= 0.51; P = .60). In this study, age at revision cochlear implantation was not related to postrevision speech perception performance. Advanced age should not be considered a contraindication to revision cochlear implantation.

Pitch adaptation patterns in bimodal cochlear implant users: over time and after experience.

Pitch plasticity has been observed in Hybrid cochlear implant (CI) users. Does pitch plasticity also occur in bimodal CI users with traditional long-electrode CIs, and is pitch adaptation pattern associated with electrode discrimination or speech recognition performance? The goals of this study were to characterize pitch adaptation patterns in long-electrode CI users, to correlate these patterns with electrode discrimination and speech perception outcomes, and to analyze which subject factors are associated with the different patterns. Electric-to-acoustic pitch matches were obtained in 19 subjects over time from CI activation to at least 12 months after activation, and in a separate group of 18 subjects in a single visit after at least 24 months of CI experience. Audiometric thresholds, electrode discrimination performance, and speech perception scores were also measured. Subjects measured over time had pitch adaptation patterns that fit one of the following categories: (1) "Pitch-adapting," that is, the mismatch between perceived electrode pitch and the corresponding frequency-to-electrode allocations decreased; (2) "Pitch-dropping," that is, the pitches of multiple electrodes dropped and converged to a similar low-pitch; and (3) "Pitch-unchanging," that is, the electrode pitches did not change. Subjects measured after CI experience had a parallel set of adaptation patterns: (1) "Matched-pitch," that is, the electrode pitch was matched to the frequency allocation; (2) "Low-pitch," that is, the pitches of multiple electrodes were all around the lowest frequency allocation; and (3) "Nonmatched-pitch," that is, the pitch patterns were compressed relative to the frequency allocations and did not fit either the matched-pitch or low-pitch categories. Unlike Hybrid CI users which were mostly in the pitch-adapting or matched-pitch category, the majority of bimodal CI users were in the latter two categories, pitch-dropping/low-pitch or pitch-unchanging/nonmatched-pitch. Subjects with pitch-adapting or matched-pitch patterns tended to have better low-frequency thresholds than subjects in the latter categories. Changes in electrode discrimination over time were not associated with changes in pitch differences between electrodes. Reductions in speech perception scores over time showed a weak but nonsignificant association with dropping-pitch patterns. Bimodal CI users with more residual hearing may have somewhat greater similarity to Hybrid CI users and be more likely to adapt pitch perception to reduce mismatch with the frequencies allocated to the electrodes and the acoustic hearing. In contrast, bimodal CI users with less residual hearing exhibit either no adaptation, or surprisingly, a third pattern in which the pitches of the basal electrodes drop to match the frequency range allocated to the most apical electrode. The lack of association of electrode discrimination changes with pitch changes suggests that electrode discrimination does not depend on perceived pitch differences between electrodes, but rather on some other characteristics such as timbre. In contrast, speech perception may depend more on pitch perception and the ability to distinguish pitch between electrodes, especially since during multielectrode stimulation, cues such as timbre may be less useful for discrimination.

Verbal processing speed and executive functioning in long-term cochlear implant users.

The purpose of this study was to report how verbal rehearsal speed (VRS), a form of covert speech used to maintain verbal information in working memory, and another verbal processing speed measure, perceptual encoding speed, are related to 3 domains of executive function (EF) at risk in cochlear implant (CI) users: verbal working memory, fluency-speed, and inhibition-concentration. EF, speech perception, and language outcome measures were obtained from 55 prelingually deaf, long-term CI users and matched controls with normal hearing (NH controls). Correlational analyses were used to assess relations between VRS (articulation rate), perceptual encoding speed (digit and color naming), and the outcomes in each sample. CI users displayed slower verbal processing speeds than NH controls. Verbal rehearsal speed was related to 2 EF domains in the NH sample but was unrelated to EF outcomes in CI users. Perceptual encoding speed was related to all EF domains in both groups. Verbal rehearsal speed may be less influential for EF quality in CI users than for NH controls, whereas rapid automatized labeling skills and EF are closely related in both groups. CI users may develop processing strategies in EF tasks that differ from the covert speech strategies routinely employed by NH individuals.

Influence of Age at Revision Cochlear Implantation on Speech Perception Outcomes

Influence of Age at Revision Cochlear Implantation on Speech Perception Outcomes

Benefit from, and acclimatization to, frequency compression hearing aids in experienced adult hearing-aid users

Objective: The aim was to investigate whether frequency compression (FC) hearing aids provide additional benefit to that conferred by conventional amplification. Design: Participants wore the same hearing aid with FC enabled and disabled for six weeks (ABA design) in each condition. Speech recognition tests (in both quiet and in noise) were administered alongside two questionnaires. Performance was compared across the two signal processing conditions and at different time points. Study sample: Twelve experienced hearing-aid users (aged 65–84 years old) with moderate-to-severe high-frequency hearing loss participated in the study. Results: FC resulted in statistically significantly higher mean scores in all of the administered speech tests. Improvements over time were limited to high frequency phoneme perception. No effect of FC on self-report outcomes was observed. Conclusions: FC may lead to significant improvements in speech perception outcomes in both quiet and noise for many individuals. No participant was significantly disadvantaged by the use of FC.

Remote programming of cochlear implants.

To verify the effectiveness of remote programming of cochlear implants by stimulation levels and results in the perception of speech and free-field audiometry tests. Twelve patients from both genders, aged between 18 and 59 years, users of internal cochlear implant and speech processor of the same model for at least 12 months, were selected. Both the remote programming (RP) and the live programming (LP) were performed on the same day, measuring the minimum (T) and maximum (C) stimulation levels of five electrodes with the interpolation of the remaining ones. Speech perception tests were applied using 65 dBSPL (recorded open context sentences and monosyllables). The patients were submitted to free-field audiometry at 250-8,000 Hz frequencies. The results for the RP and LP were compared. Differences in mean of the T levels for three electrodes and the C levels for one electrode were found. No difference between the results was obtained in the speech perception tests and audiometric thresholds in the RP and LP. The RP is a simple and effective procedure for programming cochlear implant devices and, although there were differences in the stimulation levels of some electrodes, it did not interfere in the speech perception outcomes.

Optimizing frequency-to-electrode allocation for individual cochlear implant users.

Individual adjustment of frequency-to-electrode assignment in cochlear implants (CIs) may potentially improve speech perception outcomes. Twelve adult CI users were recruited for an experiment, in which frequency maps were adjusted using insertion angles estimated from post-operative x rays; results were analyzed for ten participants with good quality x rays. The allocations were a mapping to the Greenwood function, a compressed map limited to the area containing spiral ganglion (SG) cells, a reduced frequency range map (RFR), and participants' clinical maps. A trial period of at least six weeks was given for the clinical, Greenwood, and SG maps although participants could return to their clinical map if they wished. Performance with the Greenwood map was poor for both sentence and vowel perception and correlated with insertion angle; performance with the SG map was poorer than for the clinical map. The RFR map was significantly better than the clinical map for three participants, for sentence perception, but worse for three others. Those with improved performance had relatively deep insertions and poor electrode discrimination ability for apical electrodes. The results suggest that CI performance could be improved by adjustment of the frequency allocation, based on a measure of insertion angle and/or electrode discrimination ability.

Long-term follow-up of hearing preservation in electric-acoustic stimulation patients.

Hearing preservation (HP) surgery was initiated more than 10 years ago for combined electric and acoustic stimulation (EAS). Preserved residual low-frequency hearing has been demonstrated to improve speech perception in noise as well as music appreciation in EAS users up to 2 years. Multiple study groups aimed to evaluate initial loss of residual hearing (RH) as a consequence of HP surgery. However, after 1 year and 2 years of follow-up, further decline was reported. This study aimed to determine RH, speech perception, and the subjective benefits of EAS 10 years after HP surgery. Nine postlingual EAS partially deaf patients who underwent HP surgery at Antwerp University Hospital were included in this study (11 implanted ears). Hearing preservation (0% = loss of hearing; >0%-25% = minimal HP; >25%-75% = partial HP; >75% = complete HP), speech perception and subjective benefits were evaluated preoperatively; at 3, 6, 12, 18, and 24 months postoperatively; and annually thereafter. Complete HP was obtained in three of 11 ears; partial HP in five of 11 ears; and minimal HP in two of 11 ears, measured during their most recent follow-up. One subject lost his RH completely across time. The mean rate of HP was 48% (ranging from 6 months up to 10 years postoperatively). Speech perception analysis up to 10 years showed a continuous statistically significant improvement. The maximum subjective benefit was reached 3 months after implantation and subsequently remained statistically significant unchanged for the next 10 years. Long-term HP in EAS users after HP surgery is feasible, although a small continuous decline of HP rate of 3% per year was observed (measured from first fitting up to 6 years postoperative). Nevertheless, a continuous improvement was found in the speech perception results of the EAS users across 10 years. Moreover, the positive subjective benefit, assessed 3 months postoperative, remained stable up to 10 years.

The advantages of sound localization and speech perception of bilateral electric acoustic stimulation

Conclusion: Bilateral electric acoustic stimulation (EAS) effectively improved speech perception in noise and sound localization in patients with high-frequency hearing loss. Objective: To evaluate bilateral EAS efficacy of sound localization detection and speech perception in noise in two cases of high-frequency hearing loss. Methods: Two female patients, aged 38 and 45 years, respectively, received bilateral EAS sequentially. Pure-tone audiometry was performed preoperatively and postoperatively to evaluate the hearing preservation in the lower frequencies. Speech perception outcomes in quiet and noise and sound localization were assessed with unilateral and bilateral EAS. Results: Residual hearing in the lower frequencies was well preserved after insertion of a FLEX24 electrode (24 mm) using the round window approach. After bilateral EAS, speech perception improved in quiet and even more so in noise. In addition, the sound localization ability of both cases with bilateral EAS improved remarkably.

Improved outcomes in auditory brainstem implantation with the use of near-field electrical compound action potentials.

To compare the outcomes (auditory threshold and open-set speech perception at 48-month follow-up) of a new near-field monitoring procedure, electrical compound action potential, on positioning the auditory brainstem implant electrode array on the surface of the cochlear nuclei versus the traditional far-field electrical auditory brainstem response. Retrospective study. Tertiary referral center. Among the 202 patients with auditory brainstem implants fitted and monitored with electrical auditory brainstem response during implant fitting, 9 also underwent electrical compound action potential recording. These subjects were matched retrospectively with a control group of 9 patients in whom only the electrical auditory brainstem response was recorded. Electrical compound action potentials were obtained using a cotton-wick recording electrode located near the surface of the cochlear nuclei and on several cranial nerves. Significantly lower potential thresholds were observed with the recording electrode located on the cochlear nuclei surface compared with the electrical auditory brainstem response (104.4 ± 32.5 vs 158.9 ± 24.2, P = .0030). Electrical brainstem response and compound action potentials identified effects on the neighboring cranial nerves on 3.2 ± 2.4 and 7.8 ± 3.2 electrodes, respectively (P = .0034). Open-set speech perception outcomes at 48-month follow-up had improved significantly in the near- versus far-field recording groups (78.9% versus 56.7%; P = .0051). Electrical compound action potentials during auditory brainstem implantation significantly improved the definition of the potential threshold and the number of auditory and extra-auditory waves generated. It led to the best coupling between the electrode array and cochlear nuclei, significantly improving the overall open-set speech perception.

Clinical and psychosocial risk factors of hearing outcome in older adults with cochlear implants.

To identify psychosocial determinants of speech perception (SP) outcome in older adults after cochlear implant (CI) surgery. Retrospective study. Subjects received their CI at age 45 years or older and had at least 12 months of device experience. Independent variables consisted of the Charlson Comorbidity Index, history of depression, length of hearing loss and amplification use, residential status, education and gaps in SP data. Regression models were evaluated for associations with open-set SP gains at 3 months and 12 months, and in the 6- to 12-month time interval. Every 10% increase in the proportion of life spent using a hearing aid was associated with a 2% to 3% decrement in SP gain within the first 3 months of CI use. Later and overall 1y SP gains were negatively impacted by poorer general health, lower education level, and residence in an assisted-living facility. Patients with gaps in SP data at later time points were also more likely to have poorer health and to live in assisted-living facilities. The absence of two or more evaluations was associated on average with 6.3% lower SP outcome compared to subjects with one or fewer missing data points. Age at CI had no influence on the size of post-operative SP gains. Auditory deprivation and the influence of psychosocial and health factors on engagement in postsurgical rehabilitation services may impact CI outcomes more than has been previously reported. These findings have policy implications and highlight the need for more effective delivery of hearing rehabilitation services to an aging population.

Intraoperative Round Window Electrocochleography and Speech Perception Outcomes in Pediatric Cochlear Implant Recipients

Objectives: (1) Understand how intraoperative electrocochleograpy (ECoG) is used for assessing residual cochlear function in pediatric implant recipients. (2) Appreciate the utility of electrocochleograpy in predicting speech perception outcomes. Methods: A prospective cohort study of pediatric cochlear implant patients at a tertiary hospital was conducted starting in July 2011 and is ongoing. ECoG recordings were obtained from 77 children (89 ears) during cochlear implantation and provided a total response metric that can quantify the underlying hair cell and neural health. Follow-up speech perception tests were conducted at ≥7 months postoperatively with the phonetically balanced kindergarten (PB-k) word lists (n = 24). PB-k scores were compared to ECoG total response and other clinical and audiologic variables using multiple linear regression analysis in order to construct a parsimonious model for predicting speech outcomes. Results: Postoperative PB-k scores were significantly correlated with ECoG total response ( r2 = 0.32, P = .006) and preoperative pure tone averages (PTA; r2 = 0.41, P = .001). ECoG total response was weakly and inversely correlated with PTA ( r2 = 0.14, P = .001, n = 89). Hierarchical multiple linear regression identified a model for speech perception performance that included preoperative PTA, duration of cochlear implant use, and ECoG total response that predicted about half of the variance in PB-k performance (adjusted r2 = 0.49, P = .002). Conclusions: Intraoperative ECoG recordings are significantly correlated with speech perception outcomes in pediatric cochlear implant recipients and alone can account for a similar proportion of variance in speech perception when compared to other bioaudiometric factors. ECoG provides useful prognostic information about attainment of open set speech perception in children.

Impedance, Neural Response Telemetry, and Speech Perception Outcomes After Reimplantation of Cochlear Implants in Children

To compare mean impedance levels, neural response telemetry (NRT), and auditory perception after initial and explant-reimplant pediatric cochlear implants. Retrospective case review. Tertiary referral hospital and cochlear implant program. Children 0 to 16 years inclusive who have undergone explant-reimplant of their cochlear implant. Impedance levels, NRT, and speech perception performance. Impedance, NRT, and auditory perception at switch on, 3 months, 12 months, 3 years, and 5 years after initial cochlear implant and reimplantation. The explant-reimplant group receiving Cochlear contour array had significantly (p < 0.001) raised impedance at switch on, 3 months, 12 months, and 3 years, compared with their initial implant. The explant-reimplant group receiving Cochlear straight array had marginally significant (p = 0.045) raised impedance at switch on, 3 months, 12 months, and 3 and 5 years. Infection was associated with greater increases in impedance in the reimplant Contour group. NRT was increased in the explant-reimplant group but not significantly (p = 0.06). Auditory perception returned to preexplant levels within 6 months in 61% of children. Impedance is higher after explant-reimplant and remains increased for years after explant-reimplant with Cochlear contour and to a lesser degree the straight array device.

Management of Pediatric Patients with X‐Linked Stapes Gusher Syndrome

Objectives: Present outcomes of children with X-linked stapes gusher (XLSG) syndrome managed at a single institution. Methods: A retrospective evaluation of children with radiographically confirmed XLSG was undertaken. Additionally, an analysis of surgical complications and speech perception outcomes in the published literature was carried out. Results: Eight male children with XLSG identified in the first year of life were included in the single institutional review. All demonstrated varying levels of mixed hearing loss with present acoustic reflexes. There was no associated medical comorbidities or intellectual disability. The average pure tone average (PTA) at initiation of care was 90 ± 14 dB HL. All patients were initially managed with conventional amplification and 4 went on to receive cochlear implants (mean age 7 years). Speech perception abilities were variable amongst the implanted children (PBK range = 8-84%) despite radiographically confirmed electrode placement. One patient was too young to test. Children using amplification alone (n = 4) also demonstrated variable results. Literature review identified 21 other XLSG patients with cochlear implants (1 bilateral). Surgical complications included 4 postoperative cerebrospinal fluid leaks, 4 electrodes placed into the internal auditory canal, 2 electrode extrusions, and one device failure. Speech perception testing revealed 12 patients with open set abilities, 3 with closed set abilities, and 5 with only sound detection. Conclusions: Some children with XLSG can be managed with amplification alone. Cochlear implantation, while possible, presents issues with electrode placement, cerebrospinal fluid management and variable outcomes. Careful planning is needed in children with XLSG to minimize risk and optimize outcomes.