ElizabethL.Perkins,MDOtolaryngology,HeadandNeckSurgeryresidentintraining

UNCatChapelHill,NC

EffectofCochlearImplantCandidacyDelayonSpeechPercepFonOutcomesinChildrenwithBilateralImplants

EffectofCochlearImplantCandidacyDelayonSpeechPercepFonOutcomesinChildrenwithBilateralImplants

ElizabethL.Perkins,MD,LisaR.ParkAuD,ErikaGagnonAuD,HollyFBTeagleAuD,JenniferWoodardAuDandKevinD.BrownMD,PhD

Wehavenodisclosures

AdvantagesofPediatricBilateralCochlearImplants•  BilateralCIhasbecomestandardofcareforbilateralseveretoprofoundSNHL–  ImprovedsoundlocalizaNon–  ImprovedspeechpercepNoninquietandnoise– Reducedlisteningeffort– Languagedevelopment

TimingofimplantaNon•  BilateralseveretoprofoundSNHL

– EarlierisbeQer…offerCIstarNngasearlyas6-7months–  ImplantaNonunder12monthsofageprovidestheopportunityforlanguagedevelopmentcomparabletochildrenwithnormalhearing

– shorterinterdeviceintervalcanimprovelanguagedevelopmentandspeechpercepNonoutcomes

•  Whataboutbimodalchildrenwithbilateral,progressiveSNHL?

SecondSidedImplantaNoninProgressiveSNHL•  TheidealNmingforsecondsideCIinchildrenwithbimodallisteningisnotalwaysclear

•  BalanceofpotenNallossofresidualacousNchearingwithbenefitsofbilateralCI

•  OpNmalNmingandcriteriaforsecondsidedCIinprogressiveSNHLhasyettobeestablished

WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?

WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?

HowdowedeterminecandidacyforsecondsidedimplantaNon?

WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?

HowdowedeterminecandidacyforsecondsidedimplantaNon?

Methods•  RetrospecNvechartreview<18yearsofageofchildrenwhoreceivedasecondCIfollowingbimodaldeviceuse– Exclusions:revisionsurgery,lessthan6mouse,majorinnerearmalformaNonsorcochlearnervedeficiency

– 60childrenidenNfied•  Highestpre-opspeechpercepNonandpost-opCNCwordscoreswereidenNfiedforeachear– Pre-andpost-operaNvespeechpercepNontesNngpreformedat60dBSPL

Methods•  Candidacydate:whentheearreachesCNCscoreof40%orless

– Youngchildren:whenseveretoprofoundSNHLwasestablished•  CandidacyNme:theperiodofNmebetweenreachingthecandidacydateanddateofsurgery

•  CNCdifference=Bestpost-operaNveCNCscoreLONGERcandidacyNmeBestpost-operaNveCNCscore

SHORTERcandidacyNme-

Methods

CNC<40% Dateofsurgery

CNC<40% Dateofsurgery

Candidacydate

Dxhearingloss

CandidacyFme

CandidacyFme

Dxhearingloss

Longerdeafenedear

Shorterdeafenedear

Bestpost-opCNCscore

Bestpost-opCNCscore

=CNCdifference

-

Candidacydate

Methods•  StaNsNcalAnalysis

1.  MulNpleregressionanalysisonCNCdifferencescoreandbetweeneardifferencesin:

•  Interdeviceinterval•  Pre-operaNvePTA•  Ageattest•  CandidacyNme•  Surgeon,surgicalapproach,andarray

2.  LinearregressionanalysiscomparingCNCdifferencescoresbetweenearsincandidacyNme

3.  T-testanalysisoftheaverageCNCdifferencescores

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

Results3years

R2=0.097,(p=0.016)

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)

Conclusions

•  NoaudiologiccriteriaexistforsecondsideimplantaNoninbimodallisteners

•  WepresentspeechpercepNonoutcomesfollowingsequenNalCIoncechildrenreachaconservaNvecandidacy<40%

•  OurresultsdemonstratedthatdelayingimplantaNonleadstopooreroutcomes,parNcularlybeyond3-4years

•  InterdeviceintervalisnotaspredicNveofoutcomesasdifferenceincandidacydelayinthispopulaNon

Conclusions

•  BilateralcochlearimplantaNonwithalimitedcandidacydelaycanallowforopNmalspeechandlanguagedevelopment

•  SecondsideimplantaNonshouldreallybeconsideredwhenaidedspeechpercepNondeclinesbelowthepotenNalbenefitofCI

•  ParentsshouldbecounseledthatNmeforcochlearimplantaNoniswhenthechildreachescandidacy

WhenisitidealtooffersecondsideCIinchildrenwithprogressiveSNHL?

HowdowedeterminecandidacyforsecondsidedimplantaNon?

Thankyou

•  Mentor:KevinD.BrownMD,PhD•  Audiology:LisaR.ParkAuD,ErikaGagnonAuD,HollyFBTeagleAuD,JenniferWoodardAuD

•  TheChildren’sCochlearImplantCenteratUNC