effect of cochlear implant candidacy delay on speech ......• age at test • candidacy nme •...
Post on 21-Oct-2020
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ElizabethL.Perkins,MDOtolaryngology,HeadandNeckSurgeryresidentintraining
UNCatChapelHill,NC
EffectofCochlearImplantCandidacyDelayonSpeechPercepFonOutcomesinChildrenwithBilateralImplants
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EffectofCochlearImplantCandidacyDelayonSpeechPercepFonOutcomesinChildrenwithBilateralImplants
ElizabethL.Perkins,MD,LisaR.ParkAuD,ErikaGagnonAuD,HollyFBTeagleAuD,JenniferWoodardAuDandKevinD.BrownMD,PhD
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Wehavenodisclosures
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AdvantagesofPediatricBilateralCochlearImplants• BilateralCIhasbecomestandardofcareforbilateralseveretoprofoundSNHL– ImprovedsoundlocalizaNon– ImprovedspeechpercepNoninquietandnoise– Reducedlisteningeffort– Languagedevelopment
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TimingofimplantaNon• BilateralseveretoprofoundSNHL
– EarlierisbeQer…offerCIstarNngasearlyas6-7months– ImplantaNonunder12monthsofageprovidestheopportunityforlanguagedevelopmentcomparabletochildrenwithnormalhearing
– shorterinterdeviceintervalcanimprovelanguagedevelopmentandspeechpercepNonoutcomes
• Whataboutbimodalchildrenwithbilateral,progressiveSNHL?
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SecondSidedImplantaNoninProgressiveSNHL• TheidealNmingforsecondsideCIinchildrenwithbimodallisteningisnotalwaysclear
• BalanceofpotenNallossofresidualacousNchearingwithbenefitsofbilateralCI
• OpNmalNmingandcriteriaforsecondsidedCIinprogressiveSNHLhasyettobeestablished
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WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?
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WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?
HowdowedeterminecandidacyforsecondsidedimplantaNon?
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WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?
HowdowedeterminecandidacyforsecondsidedimplantaNon?
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Methods• RetrospecNvechartreview<18yearsofageofchildrenwhoreceivedasecondCIfollowingbimodaldeviceuse– Exclusions:revisionsurgery,lessthan6mouse,majorinnerearmalformaNonsorcochlearnervedeficiency
– 60childrenidenNfied• Highestpre-opspeechpercepNonandpost-opCNCwordscoreswereidenNfiedforeachear– Pre-andpost-operaNvespeechpercepNontesNngpreformedat60dBSPL
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Methods• Candidacydate:whentheearreachesCNCscoreof40%orless
– Youngchildren:whenseveretoprofoundSNHLwasestablished• CandidacyNme:theperiodofNmebetweenreachingthecandidacydateanddateofsurgery
• CNCdifference=Bestpost-operaNveCNCscoreLONGERcandidacyNmeBestpost-operaNveCNCscore
SHORTERcandidacyNme-
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Methods
CNC<40% Dateofsurgery
CNC<40% Dateofsurgery
Candidacydate
Dxhearingloss
CandidacyFme
CandidacyFme
Dxhearingloss
Longerdeafenedear
Shorterdeafenedear
Bestpost-opCNCscore
Bestpost-opCNCscore
=CNCdifference
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Candidacydate
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Methods• StaNsNcalAnalysis
1. MulNpleregressionanalysisonCNCdifferencescoreandbetweeneardifferencesin:
• Interdeviceinterval• Pre-operaNvePTA• Ageattest• CandidacyNme• Surgeon,surgicalapproach,andarray
2. LinearregressionanalysiscomparingCNCdifferencescoresbetweenearsincandidacyNme
3. T-testanalysisoftheaverageCNCdifferencescores
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Results
Variable B SEB ϐ pIntercept -1.604 2.876 0.58PTADifference 0.039 0.073 0.068 0.598CandidacyTimeDifference -2.982 1.277 -0.547 0.023Interval 1.636 1.324 0.300 0.222DifferentArray 0.472 4.199 0.017 0.911DifferentSurgeon -1.475 4.269 -0.056 0.731DifferentApproach 6.732 4.416 0.218 0.133TestAgeDifference 2.74 3.098 0.114 0.242
*p
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Results3years
R2=0.097,(p=0.016)
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Results
-12.00
-10.00
-8.00
-6.00
-4.00
-2.00
0.00C
NC
Wor
d S
core
Diff
eren
ce
(Lon
ger-
Sho
rter)
Average CNC Difference by Delay Time for the Longer Deafened Ear
< 1 year
> 1 year
< 3 years
> 3 years
< 5 years
> 5 years
*
*(*p<.005)
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Conclusions
• NoaudiologiccriteriaexistforsecondsideimplantaNoninbimodallisteners
• WepresentspeechpercepNonoutcomesfollowingsequenNalCIoncechildrenreachaconservaNvecandidacy<40%
• OurresultsdemonstratedthatdelayingimplantaNonleadstopooreroutcomes,parNcularlybeyond3-4years
• InterdeviceintervalisnotaspredicNveofoutcomesasdifferenceincandidacydelayinthispopulaNon
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Conclusions
• BilateralcochlearimplantaNonwithalimitedcandidacydelaycanallowforopNmalspeechandlanguagedevelopment
• SecondsideimplantaNonshouldreallybeconsideredwhenaidedspeechpercepNondeclinesbelowthepotenNalbenefitofCI
• ParentsshouldbecounseledthatNmeforcochlearimplantaNoniswhenthechildreachescandidacy
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WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?
HowdowedeterminecandidacyforsecondsidedimplantaNon?
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Thankyou
• Mentor:KevinD.BrownMD,PhD• Audiology:LisaR.ParkAuD,ErikaGagnonAuD,HollyFBTeagleAuD,JenniferWoodardAuD
• TheChildren’sCochlearImplantCenteratUNC
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