Intra-operative monitoring of residual hearing may be possible in most patients undergoing cochlear implantation. This pilot study suggests that cochleostomy is not associated with intra-operative loss of residual hearing; ECOG can be preserved during the procedure in most patients; intra-operative loss of hearing is most likely to occur when the tip of the array reaches the basal turn of the cochlea. This risk may increase if the array has to be removed and re-inserted. Suction of perilymph causes immediate changes, which may not recover.

Auditory Neuropathy Spectrum Disorder (ANSD) has been identified in 12 of the 75 children who received a cochlear implant at SCIC following identification through newborn infant screening. The longitudinal outcomes of 5 of these children who have thin or absent auditory nerves will be discussed in this paper with attention to the preoperative and postoperative management and factors impacting on their results. Implications for future management of children with ANSD will be addressed.

A proportion of adult cochlear implant recipients report an inability to use the signal from their cochlear implant effectively at varying post-operative intervals following cochlear implantation. Some of these recipients report deterioration in their ability to use the implant signal and do not benefit from map optimization. Others never attain the level of outcome that they had expected. Speech perception, functional listening in certain circumstances and EABR may demonstrate high performance with the cochlear implant. However recipients report extreme difficulty in noise and distortion of the signal with the cochlear implant. Commonly, environmental sounds overshadow speech. Cortical evoked potentials were measured in a group of recipients who had been reporting such difficulties. They revealed potential processing abnormalities at the level of the cortex in some of these cases. This paper will review the five result profiles that were obtained based on pre-operative, intra-operative and post-operative outcomes. It will begin to explore the value of predictive factors that may indicate the difficulties these recipients would experience post-operatively. Further, management strategies to evaluate and assist in optimizing performance will be addressed.

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