Surgical Factors in Pediatric Cochlear Implantation and Their Early Effects on Electrode Activation and Functional Outcomes

Abstract

Objective-To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation.Study Design-Prospective multicenter cohort study. Setting-Six tertiary referral centers.Patients-Children 5 years or younger before implantation with normal nonverbal intelligence. Intervention-Cochlear implant operations in 209 ears of 188 children.Main Outcome Measures-Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores.Results-Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up.Conclusion-Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array. Multiple factors likely influence speech perception and language outcomes after early cochlear implantation (1,2). Medical, surgical, and anatomic factors may contribute to variability in these outcomes as suggested by the influence of electrode position on speech perception results in adults (3,4). Although long-term morbidity rarely results from perioperative complications (5-7), the long-term effects on device function and patient outcome are less clear. The present report examines whether optimization of surgical implantation represents an opportunity for greater implant benefit.We considered surgery-related variables, including cochlear anatomy, cause, and complications alongside other child, environmental, and device variables to assess effects on auditory behavior and receptive language at 2 years after surgery. Our goal was to examine how surgical factors relate to device function and their early effects on auditory performance and verbal language comprehension. Methods Study PopulationThe Childhood Development after Cochlear Implantation study is a multicenter prospective cohort study designed to analyze the predictive val...

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