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Jafari Z, Fitzpatrick EM, Schramm DR, Rouillon I, Koravand A. Prognostic Value of Electrophysiological and MRI Findings for Pediatric Cochlear Implant Outcomes: A Systematic Review. Am J Audiol 2024; 33:1023-1040. [PMID: 39018270 DOI: 10.1044/2024_aja-23-00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI), electric compound action potential (eCAP), and electric auditory brainstem response (eABR) are among the routine assessments performed before and/or after cochlear implantation. The objective of this review was to systematically summarize and critically appraise existing evidence of the prognostic value of eCAP, eABR, and MRI for predicting post-cochlear implant (CI) speech perception outcomes in children, with a particular focus on the lesion site. METHOD The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Three electronic databases (ProQuest, PubMed, and Scopus) were searched with no restrictions on language, publication status, or year of publication. Studies on children identified with sensorineural hearing loss, auditory neuropathy spectrum disorder, cochlear nerve deficiency, or cochleovestibular nerve abnormalities reporting the relevance of eCAP, eABR, and/or MRI results to CI speech perception outcomes were included. The literature search yielded 1,887 publications. Methodological quality and strength of evidence were assessed by the Crowe Critical Appraisal Tool and the Grading of Recommendations Assessment, Development, and Evaluation tool, respectively. RESULTS Of the 25 included studies, the relevance of eCAP, eABR, and/or MRI findings to post-CI speech perception outcomes was reported in 10, 11, and 11 studies, respectively. The studies were strongly in support of the prognostic value of eABR and MRI for CI outcomes. However, the relevance of eCAP findings to speech perception outcomes was uncertain. CONCLUSION Despite the promising findings, caution is warranted in interpreting them due to the observational and retrospective design of the included studies, as well as the heterogeneity of the population and the limited control of confounding factors within these studies. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26169859.
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Affiliation(s)
- Zahra Jafari
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ontario, Canada
| | - Elizabeth M Fitzpatrick
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ontario, Canada
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada
| | - David R Schramm
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ontario, Canada
| | - Isabelle Rouillon
- Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Amineh Koravand
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ontario, Canada
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Jafari Z, Fitzpatrick EM, Schramm DR, Rouillon I, Koravand A. An Umbrella Review of Cochlear Implant Outcomes in Children With Auditory Neuropathy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4160-4176. [PMID: 37647160 DOI: 10.1044/2023_jslhr-23-00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE The objective of this overview of systematic reviews (SRs; umbrella review) was to systematically summarize and critically appraise current evidence of cochlear implant (CI) outcomes in children with auditory neuropathy spectrum disorder (ANSD). METHOD This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. The methodological quality and the risk of bias in the included SRs were assessed using A MeaSurement Tool to Assess systematic Reviews 2 checklist and the Risk of Bias in Systematic Reviews tool, respectively. RESULTS According to eight included SRs, children with ANSD achieve CI outcomes (speech perception performance) similar to their peers with sensorineural hearing loss. In children with postsynaptic ANSD (cochlear nerve deficiency), cochlear nerve hypoplasia is associated with better speech recognition outcomes compared with cochlear nerve aplasia, especially in the absence of additional disabilities. Except for one study, the overall quality of the included SRs was critically low, and except for three studies, evidence of a high risk of bias was identified in other included SRs. CONCLUSIONS Current evidence supports CI benefits for children with ANSD. To improve the quality of evidence, well-designed, prospective studies with appropriate sample sizes, using valid outcome measures, clarifying matching criteria, and taking into account the role of confounding factors are essential.
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Affiliation(s)
- Zahra Jafari
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ontario, Canada
| | - Elizabeth M Fitzpatrick
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ontario, Canada
- Child Hearing Laboratory, CHEO Research Institute, Ottawa, Ontario, Canada
| | - David R Schramm
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ontario, Canada
| | - Isabelle Rouillon
- Speech and Language Pathology, and Otolaryngology Department, Necker Hospital, Paris, France
| | - Amineh Koravand
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ontario, Canada
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Keintzel T, Raffelsberger T, Niederwanger L, Gundacker G, Rasse T. Systematic Literature Review and Early Benefit of Cochlear Implantation in Two Pediatric Auditory Neuropathy Cases. J Pers Med 2023; 13:jpm13050848. [PMID: 37241018 DOI: 10.3390/jpm13050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Approximately 1 in 10 children with hearing loss is affected by auditory neuropathy spectrum disorder (ANSD). People who have ANSD usually have great difficulty understanding speech or communicating. However, it is possible for these patients to have audiograms that may indicate profound hearing loss up to normal hearing. This disorder is prognosed with positive, intact or present otoacoustic emissions (OAE) and/or cochlear microphonics (CM) as well as abnormal or absent auditory brainstem responses (ABR). Treatment methods include conventional hearing aids as well as cochlear implants. Cochlear implants (CI) usually promise better speech understanding for ANSD patients. We performed a systematic literature review aiming to show what improvements can effectively be achieved with cochlear implants in children with ANSD and compare this with our experience with two cases of ANSD implanted at our clinic. The retrospective review of two young CI patients diagnosed with ANSD during infancy demonstrated improvements over time in speech development communicated by their parents.
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Affiliation(s)
- Thomas Keintzel
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Tobias Raffelsberger
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Lisa Niederwanger
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
| | - Gina Gundacker
- Department Health and Rehabilitation Engineering, University of Applied Sciences Technikum Wien, 1200 Vienna, Austria
| | - Thomas Rasse
- Department of Otorhinolaryngology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
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Cochlear implantation of a patient with multiple sclerosis: Case report and systematic review. The Journal of Laryngology & Otology 2021; 136:176-180. [PMID: 34649636 DOI: 10.1017/s0022215121002917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mahomva C, Liu YCC, Raol N, Anne S. Diagnosis of Auditory Neuropathy Spectrum Disorder in the Neonatal Intensive Care Unit Population. Otolaryngol Head Neck Surg 2021; 166:964-969. [PMID: 34311620 DOI: 10.1177/01945998211029836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the incidence of auditory neuropathy spectrum disorder (ANSD) and its risk factors among the neonatal intensive care unit (NICU) population from 2009 to 2018 in the Pediatric Health Information System database. STUDY DESIGN Retrospective national database review. SETTING Population-based study. METHODS The Pediatric Health Information System database was queried to identify patients ≤18 years old with NICU admission and ANSD diagnosis. Patient demographics, jaundice diagnosis, use of mechanical ventilation, extracorporeal membrane oxygenation, furosemide, and/or aminoglycosides were extracted. Multivariable linear regression was used to assess trends in incidence. Chi-square analysis was used to assess differences between patients with and without ANSD. Logistic regression was used to assess factors associated with ANSD. RESULTS From 2009 to 2018, there was an increase in (1) NICU admissions from 14,079 to 24,851 (P < .001), (2) total ANSD diagnoses from 92 to 1847 (P = .001), and (3) annual total number of patients with ANSD and NICU admission increased from 4 to 16 (P = .005). There was strong correlation between the increases in total number of NICU admissions and total ANSD diagnoses over time (R = 0.76). The average ANSD incidence was 0.052% with no statistically significant change over 10 years. When compared with all NICU admissions, children with ANSD had a higher association with use of furosemide (P < .001) and ventilator (P < .001). CONCLUSION Despite a statistically significant increase in NICU admissions and total ANSD diagnosis, the incidence of ANSD in the NICU population has not increased from 2009 to 2018. Furosemide and mechanical ventilator use were associated with increased likelihood of ANSD.
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Affiliation(s)
| | - Yi-Chun Carol Liu
- Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA.,Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nikhila Raol
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Cochlear implantation in auditory neuropathy spectrum disorders: role of transtympanic electrically evoked auditory brainstem responses and serial neural response telemetry. The Journal of Laryngology & Otology 2021; 135:602-609. [PMID: 34011420 DOI: 10.1017/s0022215121001328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the utility of pre-operative transtympanic electrically evoked auditory brainstem responses and post-operative neural response telemetry in auditory neuropathy spectrum disorder patients. METHODS Four auditory neuropathy spectrum disorder patients who had undergone cochlear implantation and used it for more than one year were studied. All four patients underwent pre-operative transtympanic electrically evoked auditory brainstem response testing, intra-operative and post-operative (at 3, 6 and 12 months after switch-on) neural response telemetry, and out-patient cochlear implant electrically evoked auditory brainstem response testing (at 12 months). RESULTS Patients with better waveforms on transtympanic electrically evoked auditory brainstem response testing showed superior performance after one year of implant use. Neural response telemetry and electrically evoked auditory brainstem response measures improved in all patients. CONCLUSION Inferences related to cochlear implantation outcomes can be based on the waveform of transtympanic electrically evoked auditory brainstem responses. Robust transtympanic electrically evoked auditory brainstem responses suggest better performance. Improvements in electrically evoked auditory brainstem responses and neural response telemetry over time indicate that electrical stimulation is favourable in auditory neuropathy spectrum disorder patients. These measures provide an objective way to monitor changes and progress in auditory pathways following cochlear implantation.
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Abstract
OBJECTIVE Given the heterogeneity of papers about electrocochleography (ECochG) and cochlear implantation (CI) and the absence of a systematic review in the current literature, the aim of this work was to analyze the uses of ECochG in the different stages of CI. DATA SOURCES A search of PubMed from inception to December 8, 2019, with cross-references, was executed. Keywords were: "Cochlear Implant" OR "Cochlear Implantation" AND "Electrocochleography" OR "ECochG." The main eligibility criteria were English-language articles, investigating the use of ECochG in the different phases of CI. STUDY SELECTION Literature reviews, editorials, case reports, conference papers were excluded, as were papers in which ECochG was just sporadically executed. DATA EXTRACTION The quality of the included studies was assessed using "The Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) Statement. DATA SYNTHESIS A total of 95 articles were identified and 60 papers were included. The included articles covered a timeframe from 2003 to 2019. Of the 60 papers, 46 were human studies, 12 animal studies, and two involved more data sets. Eleven related to the diagnostic phase, 43 described intraoperative monitoring, and 10 were regarding follow-up testing. Hearing preservation was the most discussed topic with 25 included articles. CONCLUSIONS AND RELEVANCE ECochG measurements appeared to be useful in many aspects of CI, such as hearing preservation. Our review is the first that shows the evolution of the technique and how much has been achieved from the earliest experiments to the most recent signal process refinements and device implementation in CI.
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Huen M, Lee J, Westerberg BD. Use of auditory evoked potentials with electrical stimulation at the round window niche pre-operatively on a brain-injured patient: A case study. Cochlear Implants Int 2020; 22:49-55. [PMID: 32985389 DOI: 10.1080/14670100.2020.1822643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To highlight the effectiveness of using PS testing in conjunction with electrically evoked auditory evoked potentials (eAEPs) to help guide treatment plans in patients with limited behavioural responses. METHODS Case report on a 59-year-old male with traumatic brain injury. Electrophysiological measurements in conjunction with PS were performed. RESULTS eAEPs were obtained up to the thalamo-cortical region, supporting the viability of a CI in the non-implanted ear. DISCUSSION & CONCLUSION Use of PS in conjunction with electrically evoked auditory evoked potentials can provide valuable information to guide clinical decisions regarding implantation.
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Affiliation(s)
- Myron Huen
- Department of Audiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jowan Lee
- Department of Audiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian D Westerberg
- Division of Otolaryngology - Head and Neck Surgery, B.C. Rotary Hearing and Balance Centre, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Stem-cell therapy for hearing loss: are we there yet? Braz J Otorhinolaryngol 2019; 85:520-529. [PMID: 31186186 PMCID: PMC9443044 DOI: 10.1016/j.bjorl.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/28/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Mammalian hair cells and auditory neurons do not show regenerative capacity. Hence, damage to these cell types is permanent and leads to hearing loss. However, there is no treatment that re-establishes auditory function. Regenerative therapies using stem cells represent a promising alternative. Objective This article aims to review the current literature about the main types of stem cells with potential for application in cell therapy for sensorineural hearing loss, the most relevant experiments already performed in animals, as well as the advances that have been recently made in the field. Methods Research included the databases PubMed/MEDLINE, Web of Science, Science Direct and SciELO, as well as gray literature. Search strategy included the following main terms: “stem cells”, “hair cells” and “auditory neurons”. Additionally, the main terms were combined with the following secondary terms: “mesenchymal”, “iPS”, “inner ear”, “auditory”. The research was conducted independently by three researchers. Results Differentiation of stem cells into hair cells and auditory neurons has a high success rate, reaching up to 82% for the first and 100% for the latter. Remarkably, these differentiated cells are able to interact with hair cells and auditory neurons of cochlear explants through formation of new synapses. When transplanted into the cochlea of animals with hearing loss, auditory restoration has been documented to date only in deafferented animals. Conclusion Advances have been more prominent in cases of auditory neuropathy, since partial improvement of auditory nerve conditions through cell-based therapy may increase the number of patients who can successfully receive cochlear implants.
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Deterioration in Distortion Product Otoacoustic Emissions in Auditory Neuropathy Patients With Distinct Clinical and Genetic Backgrounds. Ear Hear 2019; 40:184-191. [PMID: 29688962 DOI: 10.1097/aud.0000000000000586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Auditory neuropathy (AN) is a clinical disorder characterized by the absence of auditory brainstem response and presence of otoacoustic emissions. A gradual loss of otoacoustic emissions has been reported for some cases of AN. Such cases could be diagnosed as cochlear hearing loss and lead to misunderstanding of the pathology when patients first visit clinics after the loss of otoacoustic emissions. The purpose of this study was to investigate the time course of changes in distortion product otoacoustic emissions (DPOAEs) in association with patients' genetic and clinical backgrounds, including the use of hearing aids. DESIGN DPOAE measurements from 31 patients with AN were assessed. Genetic analyses for GJB2, OTOF, and mitochondrial m.1555A> G and m.3243A> G mutations were conducted for all cases, and the analyses for CDH23 and OPA1 were conducted for the selected cases. Patients who were younger than 10 years of age at the time of AN diagnosis were designated as the pediatric AN group (22 cases), and those who were 18 years of age or older were designated as the adult AN group (9 cases). DPOAE was measured at least twice in all patients. The response rate for DPOAEs was defined and analyzed. RESULTS The pediatric AN group comprised 10 patients with OTOF mutations, 1 with GJB2 mutations, 1 with OPA1 mutation, and 10 with indefinite causes. Twelve ears (27%) showed no change in DPOAE, 20 ears (46%) showed a decrease in DPOAE, and 12 ears (27%) lost DPOAE. Loss of DPOAE occurred in one ear (2%) at 0 years of age and four ears (9%) at 1 year of age. The time courses of DPOAEs in patients with OTOF mutations were divided into those with early loss and those with no change, indicating that the mechanism for deterioration of DPOAEs includes not only the OTOF mutations but also other common modifier factors. Most, but not all, AN patients who used hearing aids showed deterioration of DPOAEs after the start of using hearing aids. A few AN patients also showed deterioration of DPOAEs before using hearing aids. The adult AN group comprised 2 patients with OPA1 mutations, 2 with OTOF mutations, and 5 with indefinite causes. Four ears (22%) showed no change in DPOAE, 13 ears (72%) showed a decrease, and one ear (6%) showed a loss of DPOAE. Although the ratio of DPOAE decrease was higher in the adult AN group than in the pediatric AN group, the ratio of DPOAE loss was lower in the adult AN group. DPOAE was not lost in all four ears with OPA1 mutations and in all four ears with OTOF mutations in the adult group. CONCLUSIONS DPOAE was decreased or lost in approximately 70% of pediatric and about 80% of adult AN patients. Eleven percent of pediatric AN patients lost DPOAEs by 1 year of age. Genetic factors were thought to have influenced the time course of DPOAEs in the pediatric AN group. In most adult AN patients, DPOAE was rarely lost regardless of the genetic cause.
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Alzhrani F, Yousef M, Almuhawas F, Almutawa H. Auditory and speech performance in cochlear implanted ANSD children. Acta Otolaryngol 2019; 139:279-283. [PMID: 30947614 DOI: 10.1080/00016489.2019.1571283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Auditory neuropathy spectrum disorder (ANSD) is a distinct type of SNHL that is characterized by the presence of otoacoustic emissions and/or cochlear microphonics. Cochlear implantation was initially not recommended for ANSD children, later studies showed variable outcomes among those subjects. OBJECTIVE To assess the auditory and speech performance of cochlear implanted children with auditory neuropathy spectrum disorder (ANSD) and to compare these results to those obtained from cochlear implanted children with sensorineural hearing loss (SNHL) Material and methods: 18 cochlear implanted children with ANSD and 40 cochlear implanted children with SNHL were included in this study. Auditory and speech performance results were compared across both subject groups using the Category of Auditory Performance (CAP) and Speech Intelligibility Rate (SIR) tests, with measurements recorded one year post implantation. RESULTS Cochlear implanted children with ANSD showed clinically significant improvements that were comparable to those observed from cochlear implanted subjects without ANSD. CONCLUSIONS Children with ANSD benefit from early cochlear implantation and can reach similar auditory and speech performance results as that achieved by children without ANSD.
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Affiliation(s)
- Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Medhat Yousef
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Audiology Unit, ENT Department, Faculty of Medicine, Menoufia University, Al Menoufia, Egypt
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hisham Almutawa
- ENT Surgery Unit, Department of Surgical Specialists, King Fahad Medical City, Riyadh, Saudi Arabia
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Sarankumar T, Arumugam SV, Goyal S, Chauhan N, Kumari A, Kameswaran M. Outcomes of Cochlear Implantation in Auditory Neuropathy Spectrum Disorder and the Role of Cortical Auditory Evoked Potentials in Benefit Evaluation. Turk Arch Otorhinolaryngol 2018; 56:15-20. [PMID: 29988272 DOI: 10.5152/tao.2017.2537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/02/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the outcomes of cochlear implantation (CI) in children with auditory neuropathy spectrum disorder (ANSD) and age-matched controls with profound sensorineural hearing loss, using categories of auditory performance (CAP), speech intelligibility rate (SIR), meaningful auditory integration scale (MAIS), and meaningful use of speech scale (MUSS), and to determine the role of Cortical Auditory Evoked Potentials (CAEP) in benefit evaluation after CI. Methods Ten patients (8 males and two females) with ANSD who underwent CI were included in the study. Auditory and speech scores were compared between baseline and after 12 months of habilitation in children with ANSD. Post CI speech scores in children with ANSD were compared with the control group (age-matched children with profound sensorineural hearing loss) at 12 months of habilitation. P1 latency of CAEP has a good correlation with auditory and speech scores in children with ANSD in the study group. Results Significant benefits were seen in children with ANSD who underwent CI compared to the baseline CAP and SIR scores and one year after habilitation. There is no statistically significant difference in outcomes between the two groups with CI (ANSD and profound sensorineural hearing loss) (p-value: CAP=1.00, SIR=0.84, MAIS=0.33, MUSS=0.08). Speech perception in noise test (SPIN) scores in children with ANSD were 63% and 80% with 0 dB signal noise ratio (SNR) and +10dB SNR, respectively. P1 wave of CAEP has a good correlation with the subjective outcomes. Conclusion CI in children with ANSD has showed benefits comparable to children with profound sensorineural hearing loss. CAEP is a useful tool in objectively assessing cortical maturity in children with ANSD following CI.
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Affiliation(s)
| | | | - Sunil Goyal
- Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
| | - Neha Chauhan
- Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
| | - Abha Kumari
- Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
| | - Mohan Kameswaran
- Department of Otorhinolaryngology, Madras ENT Research Foundation, Chennai, India
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Walker E, McCreery R, Spratford M, Roush P. Children with Auditory Neuropathy Spectrum Disorder Fitted with Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Current Practice and Outcomes. J Am Acad Audiol 2018; 27:204-218. [PMID: 26967362 DOI: 10.3766/jaaa.15050] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Up to 15% of children with permanent hearing loss (HL) have auditory neuropathy spectrum disorder (ANSD), which involves normal outer hair cell function and disordered afferent neural activity in the auditory nerve or brainstem. Given the varying presentations of ANSD in children, there is a need for more evidence-based research on appropriate clinical interventions for this population. PURPOSE This study compared the speech production, speech perception, and language outcomes of children with ANSD, who are hard of hearing, to children with similar degrees of mild-to-moderately severe sensorineural hearing loss (SNHL), all of whom were fitted with bilateral hearing aids (HAs) based on the American Academy of Audiology pediatric amplification guidelines. RESEARCH DESIGN Speech perception and communication outcomes data were gathered in a prospective accelerated longitudinal design, with entry into the study between six mo and seven yr of age. Three sites were involved in participant recruitment: Boys Town National Research Hospital, the University of North Carolina at Chapel Hill, and the University of Iowa. STUDY SAMPLE The sample consisted of 12 children with ANSD and 22 children with SNHL. The groups were matched based on better-ear pure-tone average, better-ear aided speech intelligibility index, gender, maternal education level, and newborn hearing screening result (i.e., pass or refer). DATA COLLECTION AND ANALYSIS Children and their families participated in an initial baseline visit, followed by visits twice a year for children <2 yr of age and once a yr for children >2 yr of age. Paired-sample t-tests were used to compare children with ANSD to children with SNHL. RESULTS Paired t-tests indicated no significant differences between the ANSD and SNHL groups on language and articulation measures. Children with ANSD displayed functional speech perception skills in quiet. Although the number of participants was too small to conduct statistical analyses for speech perception testing, there appeared to be a trend in which the ANSD group performed more poorly in background noise with HAs, compared to the SNHL group. CONCLUSIONS The American Academy of Audiology Pediatric Amplification Guidelines recommend that children with ANSD receive an HA trial if their behavioral thresholds are sufficiently high enough to impede speech perception at conversational levels. For children with ANSD in the mild-to-severe HL range, the current results support this recommendation, as children with ANSD can achieve functional outcomes similar to peers with SNHL.
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Han KH, Oh DY, Lee S, Lee C, Han JH, Kim MY, Park HR, Park MK, Kim NKD, Lee J, Yi E, Kim JM, Kim JW, Chae JH, Oh SH, Park WY, Choi BY. ATP1A3 mutations can cause progressive auditory neuropathy: a new gene of auditory synaptopathy. Sci Rep 2017; 7:16504. [PMID: 29184165 PMCID: PMC5705773 DOI: 10.1038/s41598-017-16676-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022] Open
Abstract
The etiologies and prevalence of sporadic, postlingual-onset, progressive auditory neuropathy spectrum disorder (ANSD) have rarely been documented. Thus, we aimed to evaluate the prevalence and molecular etiologies of these cases. Three out of 106 sporadic progressive hearing losses turned out to manifest ANSD. Through whole exome sequencing and subsequent bioinformatics analysis, two out of the three were found to share a de novo variant, p.E818K of ATP1A3, which had been reported to cause exclusively CAPOS (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) syndrome. However, hearing loss induced by CAPOS has never been characterized to date. Interestingly, the first proband did not manifest any features of CAPOS, except subclinical areflexia; however, the phenotypes of second proband was compatible with that of CAPOS, making this the first reported CAPOS allele in Koreans. This ANSD phenotype was compatible with known expression of ATP1A3 mainly in the synapse between afferent nerve and inner hair cells. Based on this, cochlear implantation (CI) was performed in the first proband, leading to remarkable benefits. Collectively, the de novo ATP1A3 variant can cause postlingual-onset auditory synaptopathy, making this gene a significant contributor to sporadic progressive ANSD and a biomarker ensuring favorable short-term CI outcomes.
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Affiliation(s)
- Kyu-Hee Han
- Department of Otorhinolaryngology, National Medical Center, Seoul, Korea
| | - Doo-Yi Oh
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seungmin Lee
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chung Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Young Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye-Rim Park
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Nayoung K D Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Jaekwang Lee
- Division of Functional Food Research, Korea Food Research Institute (KFRI), Seongnam, Korea
| | - Eunyoung Yi
- College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Muan, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Department of Molecular Cell Biology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea.
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Prabhu P. Evaluation of Depression, Anxiety, and Stress in Adolescents and Young Adults with Auditory Neuropathy Spectrum Disorder. SCIENTIFICA 2016; 2016:4378269. [PMID: 27579218 PMCID: PMC4992756 DOI: 10.1155/2016/4378269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
The aim of the present study was to determine the severity of stress, anxiety, and depression using Depression Anxiety Stress Scales (DASS) in adolescents and young adults with auditory neuropathy spectrum disorder (ANSD). DASS was administered to 20 individuals with auditory neuropathy spectrum disorder. The effect of gender on severity of anxiety, stress, and depression on DASS scores was determined. It was attempted to determine the correlation of severity of anxiety, stress, and depression with the reported onset of the problem, degree of hearing loss, and speech identification scores. The results of the study showed that individuals with ANSD had a moderate degree of depression and anxiety. The results also showed that the symptoms were more seen in females than in males. Correlation analysis revealed that DASS scores correlated with the reported onset of condition and speech identification scores (SIS) and the degree of hearing loss showed no correlation. The study concludes that individuals with ANSD experience depression and anxiety and this could be because of the inadequate management options available for individuals with ANSD. Thus, there is a need to develop appropriate management strategies for individuals with ANSD and provide appropriate referral for management of psychological issues.
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Affiliation(s)
- Prashanth Prabhu
- All India Institute of Speech and Hearing, Mysore 570 006, India
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Gökdoğan Ç, Altınyay Ş, Gündüz B, Kemaloğlu YK, Bayazıt Y, Uygur K. Management of children with auditory neuropathy spectrum disorder (ANSD). Braz J Otorhinolaryngol 2015; 82:493-9. [PMID: 26781981 PMCID: PMC9444594 DOI: 10.1016/j.bjorl.2015.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/09/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION ANSD is a challenging problem. OBJECTIVE To present our experience on management of the children with ANSD with respect to clinical data. METHODS This retrospective study included all children younger than 16 years of age who applied to the department between 2005 and 2013 (with the exception of newborn hearing screening NHS referrals). The data were derived from pure tone, OAEs and ABR tests, and further medical risk factors of the subjects were evaluated. RESULTS ANSD was recognized in 74 ears of 40 children (B/U: 34/6) among 1952 children with SNHL (2.04%) detected among 9520 applicants to the department (0.42%). The clinical tests revealed that hearing loss greater than 15dB was present in both ears of 38 cases. The degree of hearing loss was profound in 48% children, severe in 12% children, moderate in 28% children, mild in 10% children and normal in 5% children. ABRs were absent/abnormal in 37/3 ears and CMs were detected in all. Acoustic reflexes were absent in all ears. Rehabilitation was managed by CI and hearing aids in 15 and 23 cases, respectively. FM system was given to two cases displaying normal hearing but poor speech discrimination in noisy environments. CONCLUSION ANSD is a relatively challenging problem for the audiology departments because of its various clinical features and difficulties in management. Our patients with ANSD most commonly displayed profound hearing loss. The number of overlooked cases may be minimized by performing ABR and OAE in every case referred with the suspicion of hearing loss.
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Affiliation(s)
- Çağıl Gökdoğan
- Gazi University Hospital, Department of Audiology, Ankara, Turkey.
| | - Şenay Altınyay
- Gazi University Hospital, Department of Audiology, Ankara, Turkey
| | - Bülent Gündüz
- Gazi University Hospital, Department of Audiology, Ankara, Turkey
| | | | | | - Kemal Uygur
- Gazi University Hospital, Department of ENT-HNS, Ankara, Turkey
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Rance G, Starr A. Pathophysiological mechanisms and functional hearing consequences of auditory neuropathy. Brain 2015; 138:3141-58. [PMID: 26463676 DOI: 10.1093/brain/awv270] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 01/19/2023] Open
Abstract
The effects of inner ear abnormality on audibility have been explored since the early 20th century when sound detection measures were first used to define and quantify 'hearing loss'. The development in the 1970s of objective measures of cochlear hair cell function (cochlear microphonics, otoacoustic emissions, summating potentials) and auditory nerve/brainstem activity (auditory brainstem responses) have made it possible to distinguish both synaptic and auditory nerve disorders from sensory receptor loss. This distinction is critically important when considering aetiology and management. In this review we address the clinical and pathophysiological features of auditory neuropathy that distinguish site(s) of dysfunction. We describe the diagnostic criteria for: (i) presynaptic disorders affecting inner hair cells and ribbon synapses; (ii) postsynaptic disorders affecting unmyelinated auditory nerve dendrites; (iii) postsynaptic disorders affecting auditory ganglion cells and their myelinated axons and dendrites; and (iv) central neural pathway disorders affecting the auditory brainstem. We review data and principles to identify treatment options for affected patients and explore their benefits as a function of site of lesion.
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Affiliation(s)
- Gary Rance
- 1 Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Parkville 3010 Australia
| | - Arnold Starr
- 2 Department of Neurology, The University of California (Irvine), 200 S. Manchester Ave., Suite 206, Orange, CA 92868-4280, USA
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Barman A, Sinha SK, Prabhu P. Amplification strategy to enhance speech perception in individuals with auditory neuropathy spectrum disorder. HEARING BALANCE AND COMMUNICATION 2015. [DOI: 10.3109/21695717.2015.1075322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
In 1996, a new type of bilateral hearing disorder was discerned and published almost simultaneously by Kaga et al. [1] and Starr et al. [2]. Although the pathophysiology of this disorder as reported by each author was essentially identical, Kaga used the term "auditory nerve disease" and Starr used the term "auditory neuropathy". Auditory neuropathy (AN) in adults is an acquired disorder characterized by mild-to-moderate pure-tone hearing loss, poor speech discrimination, and absence of the auditory brainstem response (ABR) all in the presence of normal cochlear outer hair cell function as indicated by normal distortion product otoacoustic emissions (DPOAEs) and evoked summating potentials (SPs) by electrocochleography (ECoG). A variety of processes and etiologies are thought to be involved in its pathophysiology including mutations of the OTOF and/or OPA1 genes. Most of the subsequent reports in the literature discuss the various auditory profiles of patients with AN [3,4] and in this report we present the profiles of an additional 17 cases of adult AN. Cochlear implants are useful for the reacquisition of hearing in adult AN although hearing aids are ineffective. In 2008, the new term of Auditory Neuropathy Spectrum Disorders (ANSD) was proposed by the Colorado Children's Hospital group following a comprehensive study of newborn hearing test results. When ABRs were absent and DPOAEs were present in particular cases during newborn screening they were classified as ANSD. In 2013, our group in the Tokyo Medical Center classified ANSD into three types by following changes in ABRs and DPOAEs over time with development. In Type I, there is normalization of hearing over time, Type II shows a change into profound hearing loss and Type III is true auditory neuropathy (AN). We emphasize that, in adults, ANSD is not the same as AN.
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Affiliation(s)
- Kimitaka Kaga
- National Institute of Sensory Organs, National Tokyo Medical Center, Japan; Center for Speech and Hearing Disorders, International University of Health and Welfare, Japan.
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Sharma A, Cardon G. Cortical development and neuroplasticity in Auditory Neuropathy Spectrum Disorder. Hear Res 2015; 330:221-32. [PMID: 26070426 DOI: 10.1016/j.heares.2015.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/27/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
Cortical development is dependent to a large extent on stimulus-driven input. Auditory Neuropathy Spectrum Disorder (ANSD) is a recently described form of hearing impairment where neural dys-synchrony is the predominant characteristic. Children with ANSD provide a unique platform to examine the effects of asynchronous and degraded afferent stimulation on cortical auditory neuroplasticity and behavioral processing of sound. In this review, we describe patterns of auditory cortical maturation in children with ANSD. The disruption of cortical maturation that leads to these various patterns includes high levels of intra-individual cortical variability and deficits in cortical phase synchronization of oscillatory neural responses. These neurodevelopmental changes, which are constrained by sensitive periods for central auditory maturation, are correlated with behavioral outcomes for children with ANSD. Overall, we hypothesize that patterns of cortical development in children with ANSD appear to be markers of the severity of the underlying neural dys-synchrony, providing prognostic indicators of success of clinical intervention with amplification and/or electrical stimulation. This article is part of a Special Issue entitled <Auditory Synaptology>.
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Affiliation(s)
- Anu Sharma
- University of Colorado at Boulder, Speech, Language, and Hearing Sciences Department, Institute of Cognitive Science and Center for Neuroscience, 2501 Kittredge Loop Rd, Boulder, CO 80309, USA.
| | - Garrett Cardon
- University of Colorado at Boulder, Speech, Language, and Hearing Sciences Department, Institute of Cognitive Science and Center for Neuroscience, 2501 Kittredge Loop Rd, Boulder, CO 80309, USA
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The Role of Temporal Envelope and Fine Structure in Mandarin Lexical Tone Perception in Auditory Neuropathy Spectrum Disorder. PLoS One 2015; 10:e0129710. [PMID: 26052707 PMCID: PMC4459992 DOI: 10.1371/journal.pone.0129710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
Temporal information in a signal can be partitioned into temporal envelope (E) and fine structure (FS). Fine structure is important for lexical tone perception for normal-hearing (NH) listeners, and listeners with sensorineural hearing loss (SNHL) have an impaired ability to use FS in lexical tone perception due to the reduced frequency resolution. The present study was aimed to assess which of the acoustic aspects (E or FS) played a more important role in lexical tone perception in subjects with auditory neuropathy spectrum disorder (ANSD) and to determine whether it was the deficit in temporal resolution or frequency resolution that might lead to more detrimental effects on FS processing in pitch perception. Fifty-eight native Mandarin Chinese-speaking subjects (27 with ANSD, 16 with SNHL, and 15 with NH) were assessed for (1) their ability to recognize lexical tones using acoustic E or FS cues with the “auditory chimera” technique, (2) temporal resolution as measured with temporal gap detection (TGD) threshold, and (3) frequency resolution as measured with the Q10dB values of the psychophysical tuning curves. Overall, 26.5%, 60.2%, and 92.1% of lexical tone responses were consistent with FS cues for tone perception for listeners with ANSD, SNHL, and NH, respectively. The mean TGD threshold was significantly higher for listeners with ANSD (11.9 ms) than for SNHL (4.0 ms; p < 0.001) and NH (3.9 ms; p < 0.001) listeners, with no significant difference between SNHL and NH listeners. In contrast, the mean Q10dB for listeners with SNHL (1.8±0.4) was significantly lower than that for ANSD (3.5±1.0; p < 0.001) and NH (3.4±0.9; p < 0.001) listeners, with no significant difference between ANSD and NH listeners. These results suggest that reduced temporal resolution, as opposed to reduced frequency selectivity, in ANSD subjects leads to greater degradation of FS processing for pitch perception.
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Ji F, Li J, Hong M, Chen A, Jiao Q, Sun L, Liang S, Yang S. Determination of benefits of cochlear implantation in children with auditory neuropathy. PLoS One 2015; 10:e0127566. [PMID: 26010832 PMCID: PMC4443975 DOI: 10.1371/journal.pone.0127566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 04/16/2015] [Indexed: 11/19/2022] Open
Abstract
Background Auditory neuropathy (AN) is a recently recognized hearing disorder characterized by intact outer hair cell function, disrupted auditory nerve synchronization and poor speech perception and recognition. Cochlear implants (CIs) are currently the most promising intervention for improving hearing and speech in individuals with AN. Although previous studies have shown optimistic results, there was large variability concerning benefits of CIs among individuals with AN. The data indicate that different criteria are needed to evaluate the benefit of CIs in these children compared to those with sensorineural hearing loss. We hypothesized that a hierarchic assessment would be more appropriate to evaluate the benefits of cochlear implantation in AN individuals. Methods Eight prelingual children with AN who received unilateral CIs were included in this study. Hearing sensitivity and speech recognition were evaluated pre- and postoperatively within each subject. The efficacy of cochlear implantation was assessed using a stepwise hierarchic evaluation for achieving: (1) effective audibility, (2) improved speech recognition, (3) effective speech, and (4) effective communication. Results The postoperative hearing and speech performance varied among the subjects. According to the hierarchic assessment, all eight subjects approached the primary level of effective audibility, with an average implanted hearing threshold of 43.8 ± 10.2 dB HL. Five subjects (62.5%) attained the level of improved speech recognition, one (12.5%) reached the level of effective speech, and none of the subjects (0.0%) achieved effective communication. Conclusion CIs benefit prelingual children with AN to varying extents. A hierarchic evaluation provides a more suitable method to determine the benefits that AN individuals will likely receive from cochlear implantation.
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Affiliation(s)
- Fei Ji
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Jianan Li
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Mengdi Hong
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Aiting Chen
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Qingshan Jiao
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Li Sun
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Sichao Liang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Shiming Yang
- Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
- * E-mail:
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Uus K, Young A, Day M. Parents' perspectives on the dilemmas with intervention for infants with auditory neuropathy spectrum disorder: A qualitative study. Int J Audiol 2015; 54:552-8. [PMID: 25826252 DOI: 10.3109/14992027.2015.1020970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This paper explores parental experiences of choices surrounding auditory management and language and communication development for infants and children with auditory neuropathy spectrum disorder (ANSD) in the light of the heterogeneity of condition, a poor evidence base for best outcomes in relation to management options, and the scarcity of data rooted in parent and family experience. DESIGN Qualitative narrative study. STUDY SAMPLE Twenty-five parents of 21 children (aged four months to six years) identified with ANSD through the newborn hearing screening programme. RESULTS Families identify barriers to early management due to conflicting expert opinions and ANSD-specific challenges with diagnosis and prognosis in infants, and share their accounts on their own evaluations of intervention benefit in their children. CONCLUSIONS The results are of relevance to the clinicians and other professionals involved in early intervention, management, and support of infants with ANSD.
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Affiliation(s)
- Kai Uus
- * Audiology & Deafness Research Group, School of Psychological Sciences, Faculty of Medical & Human Sciences, the University of Manchester, Manchester Academic Health Sciences Centre (MAHSC) , Manchester , UK
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Objective measures of electrode discrimination with electrically evoked auditory change complex and speech-perception abilities in children with auditory neuropathy spectrum disorder. Ear Hear 2015; 35:e63-74. [PMID: 24231629 DOI: 10.1097/01.aud.0000436605.92129.1b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to (1) determine the sensitivity of the electrically evoked auditory change complex (eACC) to changes in stimulating electrode position; and (2) investigate the association between results of eACC measures and behavioral electrode discrimination and their association with speech-perception performance in pediatric cochlear implant (CI) users who have auditory neuropathy spectrum disorder (ANSD). DESIGN Fifteen children with ANSD ranging in age between 5.4 and 18.6 years participated in this study. All subjects used Cochlear Nucleus devices. For each subject, open-set speech-perception ability was assessed using the Phonetically Balanced Kindergarten word lists presented at 60 dB SPL, using monitored live voice in a sound booth. Behavioral and objective measures of electrode discrimination were assessed in a nonclinical test environment. The stimuli used to elicit these measures were 800 msec biphasic pulse trains delivered by a direct interface to the CI. Data were collected from two basic stimulation conditions. In the standard condition, the entire pulse train was delivered to a mid-array electrode (electrode 11 or 12) at the maximum comfortable level (C level). In the change condition, the stimulus was split into two 400 msec pulse train segments presented sequentially on two different electrodes. The stimulation level of the second 400 msec pulse train was loudness balanced to the C level of the mid-array electrode used in the standard condition. The separation between the pair of stimulating electrodes was systematically varied. For behavioral electrode-discrimination measures, each subject was required to determine whether he or she heard one or two sounds for stimuli presented in different stimulation conditions. For the eACC measures, two replicates of 100 artifact-free sweeps were recorded for each stimulation condition. RESULTS The eACC in response to changes in stimulating electrode position was recorded from all subjects with ANSD using direct electrical stimulation. Electrode-discrimination thresholds determined with the eACC and behavioral measures were consistent. Children with ANSD using CIs who showed poorer speech performance also required larger separations between the stimulating electrode pair to reliably elicit the eACC than subjects with better speech-perception performance. There was a robust correlation between electrode-discrimination capacities and speech-perception performances in subjects tested in this study. The effect of electrode separation on eACC amplitudes was not monotonic. CONCLUSIONS These results demonstrate the feasibility of using eACC to evaluate electrode-discrimination capacities in children with ANSD. These results suggest that the eACC elicited by changes in stimulating electrode position holds great promise as an objective tool for evaluating spectral-pattern detection in such subjects, which may be predictive of their potential speech-perception performance.
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Fernandes NF, Morettin M, Yamaguti EH, Costa OA, Bevilacqua MC. Performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implant: a systematic review. Braz J Otorhinolaryngol 2015; 81:85-96. [PMID: 25458263 PMCID: PMC9452214 DOI: 10.1016/j.bjorl.2014.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/03/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Currently, there are no doubts about the benefits of cochlear implants for the development of children with severe or profound hearing loss. However, there is still no consensus among researchers and professionals regarding the benefits for the improvement of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants. Objective Review the available evidence in the literature to answer the following: “What is the performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants?” Methods Systematic review of the literature through electronic database consultation, considering publications in the period 2002–2013. Results Twenty-two studies met the criteria and were included in the systematic review. Conclusion The analyzed studies demonstrated that after cochlear implant surgery, individuals with auditory neuropathy spectrum disorder improved their performance of hearing skills and had similar performance to that of children with sensorineural hearing loss using cochlear implant.
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Affiliation(s)
- Nayara Freitas Fernandes
- Department of Sciences, Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB - USP), Bauru, SP, Brazil; Department of Phonoaudiology, Universidade de São Paulo (USP), Bauru, SP, Brazil.
| | - Marina Morettin
- Department of Sciences, Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB - USP), Bauru, SP, Brazil; Department of Phonoaudiology, Universidade de São Paulo (USP), Bauru, SP, Brazil
| | - Elisabete Honda Yamaguti
- Department of Sciences, Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB - USP), Bauru, SP, Brazil; Department of Phonoaudiology, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo (HRAC - USP), Bauru, SP, Brazil
| | - Orozimbo Alves Costa
- Department of Phonoaudiology, Universidade de São Paulo (USP), Bauru, SP, Brazil; Division of Otology, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo (HRAC - USP), Bauru, SP, Brazil
| | - Maria Cecilia Bevilacqua
- Department of Phonoaudiology, Universidade de São Paulo (USP), Bauru, SP, Brazil; Department of Phonoaudiology, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo (HRAC - USP), Bauru, SP, Brazil; Division of Audiology, Hospital for Rehabilitation of Craniofacial Anomalies, Universidade de São Paulo (HRAC - USP), Bauru, SP, Brazil
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Abstract
Neural disorders of the auditory nerve are associated with particular disorders of auditory perceptions dependent on processing of acoustic temporal cues. These include: (1) speech perception; (2) localizing a sound's origin in space; and (3) identifying sounds in background noise. Auditory neuropathy (AN) is a consequence of: (1) presynaptic disorders affecting inner hair cell ribbon synapses; (2) postsynaptic disorders of auditory nerve dendrites; and (3) postsynaptic disorders of auditory nerve axons. The etiologies of these disorders are diverse, similar to other cranial or peripheral neuropathies. The pathologies cause attenuated and dyssynchronous auditory nerve discharges. Therapies and management of patients with AN are reviewed.
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Affiliation(s)
- Arnold Starr
- Departments of Neurology and Neurobiology, University of California, Irvine, CA, USA.
| | - Gary Rance
- School of Audiology, University of Melbourne, Melbourne, Australia
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Narne VK, Prabhu P, Chandan HS, Deepthi M. Audiological profiling of 198 individuals with auditory neuropathy spectrum disorder. HEARING, BALANCE AND COMMUNICATION 2014. [DOI: 10.3109/21695717.2014.938481] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Relationship between electrically evoked auditory brainstem response and auditory performance after cochlear implant in patients with auditory neuropathy spectrum disorder. Otol Neurotol 2014; 34:1261-6. [PMID: 23787967 DOI: 10.1097/mao.0b013e318291c632] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the pattern of electrically evoked auditory brainstem response (EABR) in auditory neuropathy spectrum disorder (ANSD) patients and to compare their performances with controls. STUDY DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENTS Eleven patients with ANSD and 9 control subjects with sensorineural hearing loss who did not have neural pathology. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES Patients and control subjects each received a cochlear implant (CI) and underwent EABR. EABR threshold, wave V latency, and amplitude were measured as EABR parameters. The results of EABR were categorized as good response, variable response, or no response. Speech perception ability was assessed by the categories of auditory performance (CAP) score. RESULTS All controls responded to EABR, whereas 6 of the 11 ANSD patients did not respond to EABR. The EABR threshold of the ANSD patients was measured almost within the value of disease controls. However, the Wave V latency displayed variable lengths, and the amplitude showed a wider distribution compared with the value of the disease control. The EABR response group among the ANSD patients showed relatively good performance after CI. In contrast, the nonresponse group demonstrated variable outcomes, although all of them still benefited from CI. CONCLUSION The data suggested that all ANSD patients require CI and that EABR results can help establish realistic expectations about future performance. Even if electrical stimulation fails to generate sufficiently synchronized signal for eliciting EABR, CI provides at least partial, measurable auditory benefit in ANSD.
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Ji F, Li JN, Hong MD, Wang Q, Yang SM. Preliminary performance of cochlear implants in post-lingual patients with auditory neuropathy. Acta Otolaryngol 2014; 134:280-5. [PMID: 24438694 DOI: 10.3109/00016489.2013.852689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Auditory restoration can be obtained by using cochlear implants (CIs) in post-lingual patients with auditory neuropathy (AN). However, improvements in postoperative speech recognition for these patients varied. OBJECTIVES The primary purpose of this study was to assess the postoperative performances of two post-lingual AN patients after receiving CIs. METHODS Two post-lingual AN patients received unilateral CIs and the efficacy of the implants was then evaluated. One patient was female with bilateral mid-severe hearing loss and received an implant at age 28 years. The second patient was male with severe hearing loss and he received an implant at age 15 years. The postoperative performance for both patients was evaluated. RESULTS After using the CI for 6 months, the hearing ability of both subjects was improved by the CI with an average post-implant threshold of 35 dB and 44 dB, respectively. The woman made significant progress in speech recognition with an open-set spondee recognition score of 55% and sentence recognition in quiet score of 90%. Sentence recognition in noise scores were 94% (SNR = +10 dB), 88% (SNR = +5 dB), and 80% (SNR = 0 dB). The boy achieved improved recognition scores for monosyllables (40%) and disyllables (26%), but poor sentence recognition both in quiet (0%) and in noise (0%).
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Affiliation(s)
- Fei Ji
- Department of Otolaryngology/Head and Neck Surgery, Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital , Beijing , China
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Kim LS, Jung SW, Park YD, Heo MJ. Cochlear implantation in paediatric auditory neuropathy. Cochlear Implants Int 2013; 5 Suppl 1:224-5. [DOI: 10.1179/cim.2004.5.supplement-1.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Penido RC, Isaac ML. Prevalence of auditory neuropathy spectrum disorder in an auditory health care service. Braz J Otorhinolaryngol 2013; 79:429-33. [PMID: 23929141 PMCID: PMC9442389 DOI: 10.5935/1808-8694.20130077] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/14/2013] [Indexed: 11/20/2022] Open
Abstract
Auditory neuropathy spectrum disorder (ANSD) is characterized by impairment of the auditory nerve associated with preservation of outer hair cell function. Objective To establish the prevalence of ANSD in subjects with sensorineural hearing loss (SNHL). Method This retrospective study was carried out between 2010 and 2012 and included the charts of 2,292 individuals with SNHL. Data from otolaryngological and audiological examinations based on pure-tone and speech audiometry, impedance tests, otoacoustic emissions (OAEs), and brainstem auditory evoked potentials (BAEPs) were collected. Inclusion criteria: presence of OAEs and/or cochlear microphonic (CM); absent or altered BAEPs, and normal MRI scans of the brain. Results Twenty-seven (1.2%) of the 2,292 subjects with SNHL had ANSD (37% males; 63% females). Mild SNHL was seen in 29.6% of the individuals with ANSD; 55.5% had moderate SNHL; 7.4% had severe SNHL; and 7.5% had profound SNHL. In terms of age, 14.8% were aged between zero and 20 years, 44.1% were 41 to 60 years old, and 7.4% were above the age of 60. Conclusion ANSD was seen in 1.2% of the individuals with SNHL included in this study.
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Affiliation(s)
- Rosimar Costa Penido
- School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto-SP, Brazil.
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Cochlear Implant as an Intervention in Patients with Auditory Neuropathy. J Otol 2013. [DOI: 10.1016/s1672-2930(13)50016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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He S, Grose JH, Teagle HFB, Woodard J, Park LR, Hatch DR, Buchman CA. Gap detection measured with electrically evoked auditory event-related potentials and speech-perception abilities in children with auditory neuropathy spectrum disorder. Ear Hear 2013; 34:733-44. [PMID: 23722354 PMCID: PMC3796190 DOI: 10.1097/aud.0b013e3182944bb5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed (1) to investigate the feasibility of recording the electrically evoked auditory event-related potential (eERP), including the onset P1-N1-P2 complex and the electrically evoked auditory change complex (EACC) in response to temporal gaps, in children with auditory neuropathy spectrum disorder (ANSD); and (2) to evaluate the relationship between these measures and speech-perception abilities in these subjects. DESIGN Fifteen ANSD children who are Cochlear Nucleus device users participated in this study. For each subject, the speech-processor microphone was bypassed and the eERPs were elicited by direct stimulation of one mid-array electrode (electrode 12). The stimulus was a train of biphasic current pulses 800 msec in duration. Two basic stimulation conditions were used to elicit the eERP. In the no-gap condition, the entire pulse train was delivered uninterrupted to electrode 12, and the onset P1-N1-P2 complex was measured relative to the stimulus onset. In the gapped condition, the stimulus consisted of two pulse train bursts, each being 400 msec in duration, presented sequentially on the same electrode and separated by one of five gaps (i.e., 5, 10, 20, 50, and 100 msec). Open-set speech-perception ability of these subjects with ANSD was assessed using the phonetically balanced kindergarten (PBK) word lists presented at 60 dB SPL, using monitored live voice in a sound booth. RESULTS The eERPs were recorded from all subjects with ANSD who participated in this study. There were no significant differences in test-retest reliability, root mean square amplitude or P1 latency for the onset P1-N1-P2 complex between subjects with good (>70% correct on PBK words) and poorer speech-perception performance. In general, the EACC showed less mature morphological characteristics than the onset P1-N1-P2 response recorded from the same subject. There was a robust correlation between the PBK word scores and the EACC thresholds for gap detection. Subjects with poorer speech-perception performance showed larger EACC thresholds in this study. CONCLUSIONS These results demonstrate the feasibility of recording eERPs from implanted children with ANSD, using direct electrical stimulation. Temporal-processing deficits, as demonstrated by large EACC thresholds for gap detection, might account in part for the poor speech-perception performances observed in a subgroup of implanted subjects with ANSD. This finding suggests that the EACC elicited by changes in temporal continuity (i.e., gap) holds promise as a predictor of speech-perception ability among implanted children with ANSD.
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Affiliation(s)
- Shuman He
- Department Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Runge CL, Erbe CB, McNally MT, Van Dusen C, Friedland DR, Kwitek AE, Kerschner JE. A novel otoferlin splice-site mutation in siblings with auditory neuropathy spectrum disorder. Audiol Neurootol 2013; 18:374-82. [PMID: 24135434 DOI: 10.1159/000354978] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022] Open
Abstract
We characterize a novel otoferlin mutation discovered in a sibling pair diagnosed with auditory neuropathy spectrum disorder and investigate auditory nerve function through their cochlear implants. Genetic sequencing revealed a homozygous mutation at the otoferlin splice donor site of exon 28 (IVS28 + 1G>T) in both siblings. Functional investigation showed that the intronic sequence between exons 28 and 29 was retained in the mutated minigenes that were expressed in 293T cells. Auditory nerve compound action potential recovery functions in the siblings demonstrated different rates of neural recovery, with sibling AN1 showing rapid recovery (1.14 ms) and AN2 showing average recovery (0.78 ms) compared to subjects with sensorineural hearing loss (average: adults 0.71 ms, children 0.85 ms). Differences in neural recovery were consistent with speech perception differences between the siblings. Genotype information may indicate site of lesion in hearing loss; however, additional, as yet, unknown factors may impact clinical outcomes and must be considered.
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Affiliation(s)
- Christina L Runge
- Departments of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisc., USA
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Cardon G, Sharma A. Central auditory maturation and behavioral outcome in children with auditory neuropathy spectrum disorder who use cochlear implants. Int J Audiol 2013; 52:577-86. [PMID: 23819618 DOI: 10.3109/14992027.2013.799786] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We examined cortical auditory development and behavioral outcomes in children with ANSD fitted with cochlear implants (CI). DESIGN Cortical maturation, measured by P1 cortical auditory evoked potential (CAEP) latency, was regressed against scores on the infant toddler meaningful auditory integration scale (IT-MAIS). Implantation age was also considered in relation to CAEP findings. STUDY SAMPLE Cross-sectional and longitudinal samples of 24 and 11 children, respectively, with ANSD fitted with CIs. RESULTS P1 CAEP responses were present in all children after implantation, though previous findings suggest that only 50-75% of ANSD children with hearing aids show CAEP responses. P1 CAEP latency was significantly correlated with participants' IT-MAIS scores. Furthermore, more children implanted before age two years showed normal P1 latencies, while those implanted later mainly showed delayed latencies. Longitudinal analysis revealed that most children showed normal or improved cortical maturation after implantation. CONCLUSION Cochlear implantation resulted in measureable cortical auditory development for all children with ANSD. Children fitted with CIs under age two years were more likely to show age-appropriate CAEP responses within six months after implantation, suggesting a possible sensitive period for cortical auditory development in ANSD. That CAEP responses were correlated with behavioral outcome highlights their clinical decision-making utility.
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Affiliation(s)
- Garrett Cardon
- Department of Speech, Language, and Hearing Sciences, University of Colorado, Boulder, USA
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Humphriss R, Hall A, Maddocks J, Macleod J, Sawaya K, Midgley E. Does cochlear implantation improve speech recognition in children with auditory neuropathy spectrum disorder? A systematic review. Int J Audiol 2013; 52:442-54. [DOI: 10.3109/14992027.2013.786190] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Outcomes of Cochlear Implantation in Children With Isolated Auditory Neuropathy Versus Cochlear Hearing Loss. Otol Neurotol 2013; 34:477-83. [DOI: 10.1097/mao.0b013e3182877741] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Needham K, Minter RL, Shepherd RK, Nayagam BA. Challenges for stem cells to functionally repair the damaged auditory nerve. Expert Opin Biol Ther 2013; 13:85-101. [PMID: 23094991 PMCID: PMC3543850 DOI: 10.1517/14712598.2013.728583] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In the auditory system, a specialized subset of sensory neurons are responsible for correctly relaying precise pitch and temporal cues to the brain. In individuals with severe-to-profound sensorineural hearing impairment these sensory auditory neurons can be directly stimulated by a cochlear implant, which restores sound input to the brainstem after the loss of hair cells. This neural prosthesis therefore depends on a residual population of functional neurons in order to function effectively. AREAS COVERED In severe cases of sensorineural hearing loss where the numbers of auditory neurons are significantly depleted, the benefits derived from a cochlear implant may be minimal. One way in which to restore function to the auditory nerve is to replace these lost neurons using differentiated stem cells, thus re-establishing the neural circuit required for cochlear implant function. Such a therapy relies on producing an appropriate population of electrophysiologically functional neurons from stem cells, and on these cells integrating and reconnecting in an appropriate manner in the deaf cochlea. EXPERT OPINION Here we review progress in the field to date, including some of the key functional features that stem cell-derived neurons would need to possess and how these might be enhanced using electrical stimulation from a cochlear implant.
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Affiliation(s)
- Karina Needham
- University of Melbourne, Department of Otolaryngology, East Melbourne, Australia.
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Mittal R, Ramesh AV, Panwar SS, Nilkanthan A, Nair S, Mehra PR. Auditory neuropathy spectrum disorder: its prevalence and audiological characteristics in an Indian tertiary care hospital. Int J Pediatr Otorhinolaryngol 2012; 76:1351-4. [PMID: 22795739 DOI: 10.1016/j.ijporl.2012.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 06/14/2012] [Accepted: 06/16/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Auditory neuropathy spectrum disorder (ANSD) has become a well accepted clinical entity. ANSD has now become easy to recognize with advent of test battery approach for hearing loss evaluation. However, little is known about its epidemiology and aetiology, especially its prevalence and incidence in India. This study was conducted to determine the prevalence and audiological characteristics of ANSD in our tertiary care hospital at New Delhi, India. METHODS We prospectively enrolled all the paediatric cases i.e. less than 12years of age referred to our outpatient department for hearing evaluation. All the cases were evaluated using complete audiological test battery consisting of pure tone audiometry (PTA), impedance audiometry, acoustic reflexes, otoacoustic emissions (OAE), and brain stem evoked response audiometry (BERA). The instrument used was GSI Audera. BERA with both condensation and rarefaction polarity was performed in cases with absent wave V even at highest intensity levels. The criteria used for diagnosis of ANSD was normal or near normal cochlear hair cells (sensory) function (preservation of otoacoustic emissions and/or cochlear microphonics) and absent or abnormal auditory nerve function (absent or severely abnormal auditory brainstem potentials). A repeat test battery was performed after 3months on the diagnosed cases of auditory neuropathy. Based on their behavioural findings the appropriate management programme was formulated. RESULTS A total of 487 paediatric cases were referred for hearing evaluation. 183 (37.6%) cases showed absent BERA and 26(5.3%) cases fulfilled the diagnostic criteria for ANSD. Repeat examination after 3months revealed presence of OAE's in 57.6% (15/26) cases while cochlear microphonics were present in all the 26 cases. CONCLUSION The prevalence of ANSD in our study is 5.3% and in children diagnosed with severe to profound hearing loss is 14%. Presence of cochlear microphonics with absent BERA seems to be reliable criteria for diagnosing ANSD.
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Eppsteiner RW, Shearer AE, Hildebrand MS, Deluca AP, Ji H, Dunn CC, Black-Ziegelbein EA, Casavant TL, Braun TA, Scheetz TE, Scherer SE, Hansen MR, Gantz BJ, Smith RJH. Prediction of cochlear implant performance by genetic mutation: the spiral ganglion hypothesis. Hear Res 2012; 292:51-8. [PMID: 22975204 DOI: 10.1016/j.heares.2012.08.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/16/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Up to 7% of patients with severe-to-profound deafness do not benefit from cochlear implantation. Given the high surgical implantation and clinical management cost of cochlear implantation (>$1 million lifetime cost), prospective identification of the worst performers would reduce unnecessary procedures and healthcare costs. Because cochlear implants bypass the membranous labyrinth but rely on the spiral ganglion for functionality, we hypothesize that cochlear implant (CI) performance is dictated in part by the anatomic location of the cochlear pathology that underlies the hearing loss. As a corollary, we hypothesize that because genetic testing can identify sites of cochlear pathology, it may be useful in predicting CI performance. METHODS 29 adult CI recipients with idiopathic adult-onset severe-to-profound hearing loss were studied. DNA samples were subjected to solution-based sequence capture and massively parallel sequencing using the OtoSCOPE(®) platform. The cohort was divided into three CI performance groups (good, intermediate, poor) and genetic causes of deafness were correlated with audiometric data to determine whether there was a gene-specific impact on CI performance. RESULTS The genetic cause of deafness was determined in 3/29 (10%) individuals. The two poor performers segregated mutations in TMPRSS3, a gene expressed in the spiral ganglion, while the good performer segregated mutations in LOXHD1, a gene expressed in the membranous labyrinth. Comprehensive literature review identified other good performers with mutations in membranous labyrinth-expressed genes; poor performance was associated with spiral ganglion-expressed genes. CONCLUSIONS Our data support the underlying hypothesis that mutations in genes preferentially expressed in the spiral ganglion portend poor CI performance while mutations in genes expressed in the membranous labyrinth portend good CI performance. Although the low mutation rate in known deafness genes in this cohort likely relates to the ascertainment characteristics (postlingual hearing loss in adult CI recipients), these data suggest that genetic testing should be implemented as part of the CI evaluation to test this association prospectively.
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Affiliation(s)
- Robert W Eppsteiner
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Shibata SB, Budenz CL, Bowling SA, Pfingst BE, Raphael Y. Nerve maintenance and regeneration in the damaged cochlea. Hear Res 2011; 281:56-64. [PMID: 21596129 PMCID: PMC3196294 DOI: 10.1016/j.heares.2011.04.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 04/22/2011] [Accepted: 04/23/2011] [Indexed: 12/22/2022]
Abstract
Following the onset of sensorineural hearing loss, degeneration of mechanosensitive hair cells and spiral ganglion cells (SGCs) in humans and animals occurs to variable degrees, with a trend for greater neural degeneration with greater duration of deafness. Emergence of the cochlear implant prosthesis has provided much needed aid to many hearing impaired patients and has become a well-recognized therapy worldwide. However, ongoing peripheral nerve fiber regression and subsequent degeneration of SGC bodies can reduce the neural targets of cochlear implant stimulation and diminish its function. There is increasing interest in bio-engineering approaches that aim to enhance cochlear implant efficacy by preventing SGC body degeneration and/or regenerating peripheral nerve fibers into the deaf sensory epithelium. We review the advancements in maintaining and regenerating nerves in damaged animal cochleae, with an emphasis on the therapeutic capacity of neurotrophic factors delivered to the inner ear after an insult. Additionally, we summarize the histological process of neuronal degeneration in the inner ear and describe different animal models that have been employed to study this mechanism. Research on enhancing the biological infrastructure of the deafened cochlea in order to improve cochlear implant efficacy is of immediate clinical importance.
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Affiliation(s)
- Seiji B. Shibata
- Kresge Hearing Research Institute, Department of Otolaryngology, The University of Michigan, Ann Arbor, MI, 48109-5648, USA
| | - Cameron L. Budenz
- Kresge Hearing Research Institute, Department of Otolaryngology, The University of Michigan, Ann Arbor, MI, 48109-5648, USA
| | - Sara A. Bowling
- Kresge Hearing Research Institute, Department of Otolaryngology, The University of Michigan, Ann Arbor, MI, 48109-5648, USA
| | - Bryan E. Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology, The University of Michigan, Ann Arbor, MI, 48109-5648, USA
| | - Yehoash Raphael
- Kresge Hearing Research Institute, Department of Otolaryngology, The University of Michigan, Ann Arbor, MI, 48109-5648, USA
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Goswamy J, Bruce IA, Green KMJ, O'Driscoll MP. Cochlear implantation in a patient with sensori-neural deafness secondary to Charcot-Marie-Tooth disease. Cochlear Implants Int 2011; 13:184-7. [PMID: 22333975 DOI: 10.1179/1754762811y.0000000021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE AND IMPORTANCE Charcot-Marie-Tooth (CMT) disease is the most common hereditary motor and sensory neuropathy and can result in profound sensori-neural hearing loss with deficiency in speech perception out of proportion to that which would be expected if the loss was cochlear in origin. This study investigates whether the reintroduction of auditory synchrony by means of cochlear implantation will improve speech perception in those with dys-synchrony related to impairment of temporal processing abilities secondary to CMT. CLINICAL PRESENTATION A 67-year-old male presented with a gradual but significant decrease in his hearing as part of a slowly progressing demyelinating peripheral neuropathy. On open-set speech discrimination he scored 0%. INTERVENTION A Med-el Flex(SOFT) cochlear implant (CI) was fully inserted into the left ear with no surgical complications. The CI speech processor was fitted 1 month post-implantation and standardized speech assessments conducted at 1 week, 3 months, 9 months, and 21 months following initial fitting, gave open-set speech discrimination scores of 0, 0, 53, and 54%, respectively. CONCLUSION This report demonstrates that cochlear implantation is an option to rehabilitate severe-to-profound hearing loss in adults with auditory dys-synchrony secondary to CMT disease. Progress post-implantation is likely to be slower than for the average CI user.
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Roush P, Frymark T, Venediktov R, Wang B. Audiologic management of auditory neuropathy spectrum disorder in children: a systematic review of the literature. Am J Audiol 2011; 20:159-70. [PMID: 21940978 DOI: 10.1044/1059-0889(2011/10-0032)] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This review summarizes current evidence related to the audiologic management of children with auditory neuropathy spectrum disorder (ANSD). METHOD A systematic search of the literature was conducted in 25 electronic databases (e.g., PubMed, CINAHL, and ERIC) using key words such as auditory neuropathy, auditory neuropathy spectrum disorder, auditory neuropathy/dyssynchrony, and hearing loss. Eighteen studies met the inclusion criteria by addressing 1 or more of 8 clinical questions. Studies were evaluated for methodological quality, and data regarding participant, intervention, and outcome variables are reported. RESULTS Fifteen of the 18 studies addressed the use of cochlear implantation, and 4 addressed conventional acoustic amplification. All participants demonstrated improved auditory performance; however, all 18 studies were considered exploratory, and many had methodological limitations. CONCLUSION The clinical evidence related to intervention for ANSD is at a very preliminary stage. Additional research is needed to address the efficacy of acoustic amplification and cochlear implantation in children with ANSD and the impact of this disorder on developmental outcomes.
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Affiliation(s)
| | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | | | - Beverly Wang
- American Speech-Language-Hearing Association, Rockville, MD
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Przekop A, Sanger TD. Birth-related syndromes of athetosis and kernicterus. HANDBOOK OF CLINICAL NEUROLOGY 2011; 100:387-95. [PMID: 21496597 DOI: 10.1016/b978-0-444-52014-2.00030-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
"Athetosis," from the Greek athetos, meaning "without fixed position," is a movement disorder first described by Hammond in 1871. The term described slow, irregular continual movements of the distal extremities. In 1983, Foley defined the athetoid syndrome as "a nonprogressive but evolving disorder due to damage to the basal ganglia of the full-term brain … [with] impairment of postural reflexes, arrhythmical involuntary movements, and dysarthria, [but] sparing … sensation, ocular movements and … intelligence." A decade later, "athetoid syndrome" was replaced by "dyskinetic cerebral palsy." Injury to basal ganglia by various mechanisms, including asphyxia, trauma, perinatal strokes, and kernicterus, is known to cause birth-related athetosis. Kernicterus originally described the neuropathology of bilirubin-induced brain injury, where the deep nuclei of the brain stain yellow. Kernicterus now describes the clinical features of chronic bilirubin encephalopathy, which include an extrapyramidal movement disorder, sensorineural hearing loss, impaired upward gaze, and dental enamel dysplasia. Aggressive treatment of perinatal hyperbilirubinemia has led to a decline in kernicterus so that, today, it is a rare cause of dyskinetic cerebral palsy. In this chapter, we provide a historic overview of athetosis and its formerly common cause, kernicterus. We relate earlier terminology to more recent definitions of impairments in dyskinetic cerebral palsy, including dystonia, chorea, and choreoathetosis.
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Affiliation(s)
- Allison Przekop
- Division of Pediatric Neurology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Dror AA, Avraham KB. Hearing Impairment: A Panoply of Genes and Functions. Neuron 2010; 68:293-308. [DOI: 10.1016/j.neuron.2010.10.011] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2010] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE To report the patient's characteristics, preoperative audiological profiles, surgical outcomes, and postoperative performance for children with auditory neuropathy spectrum disorder (ANSD) who ultimately received cochlear implants (CIs). DESIGN Prospective, longitudinal study of children with ANSD who received CIs after a stepwise management protocol that included electrophysiologic and medical assessment, documentation of behavioral audiometric thresholds and subsequent fitting of amplification according to Desired Sensation Level targets, auditory-based intervention with careful monitoring of skills development and communication milestones, and finally implantation when progress with the use of acoustic amplification was insufficient. RESULTS Of 140 children with ANSD, 52 (37%) received CIs in their affected ears (mean duration of use of 41 mos). Many of these children were born prematurely (42%) and impacted by a variety of medical comorbidities. More than one third (38%) had abnormal findings on preoperative magnetic resonance imaging of the brain and inner ear, and 81% had a greater than severe (>70 dB HL) degree of hearing loss before implantation. Although 50% of the implanted children with ANSD demonstrated open-set speech perception abilities after implantation, nearly 30% of them with >6 months of implant experience were unable to participate in this type of testing because of their young age or developmental delays. No child with cochlear nerve deficiency (CND) in their implanted ear achieved open-set speech perception abilities. In a subgroup of children, good open-set speech perception skills were associated with robust responses elicited on electrical-evoked intracochlear compound action potential testing when this assessment was possible. CONCLUSIONS This report shows that children with ANSD who receive CIs are a heterogeneous group with a wide variety of impairments. Although many of these children may ultimately benefit from implantation, some will not, presumably because of a lack of electrical-induced neural synchronization, the detrimental effects of their other associated conditions, or a combination of factors. When preoperative magnetic resonance imaging reveals central nervous system pathology, this portends a poor prognosis for the development of open-set speech perception, particularly when CND is evident. These results also show that electrical-evoked intracochlear compound action potential testing may help identify those children who will develop good open-set speech perception. Instead of recommending CI for all children with electrophysiologic evidence of ANSD, the stepwise management procedure described herein allows for the identification of children who may benefit from amplification, those who are appropriate candidates for cochlear implantation, and those who, because of bilateral CND, may not be appropriate candidates for either intervention.
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Kim LS, Jeong SW, Lee YM, Kim JS. Cochlear implantation in children. Auris Nasus Larynx 2010; 37:6-17. [DOI: 10.1016/j.anl.2009.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/10/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
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van den Broek E, Dunnebier EA. Cochlear implantation in postlingually hearing-impaired adults: choosing the most appropriate ear. Int J Audiol 2010; 48:618-24. [PMID: 19925335 DOI: 10.1080/14992020902931566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Choice of the most appropriate ear for CI in postlingually hearing-impaired adults is becoming more relevant as more patients are considered eligible for intervention. The aim of this study is to review factors that influence this choice and to formulate a flowchart. An extensive Medline search was performed. Factors can be divided into surgical, audiological, and patient factors. Surgical factors are anatomic variation and otological medical history. Both are divided in absolute and relative contraindications. Duration of deafness and residual hearing are combined in the audiological factor. Likeliness of improvement of speech perception after CI at different durations of deafness is estimated. This is followed by comparison of between-ear differences in duration of deafness. If there is a large difference, above the presented 5% interval, the ear with the shortest duration is preferred. This review and its flowchart are an aid for decision making in the choice of ear for CI. Being as representative of current knowledge as possible, future refinements may occur as new insights are gained.
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Affiliation(s)
- Emke van den Broek
- Department of Otorhinolaryngology, University Medical Center, Utrecht, The Netherlands
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Leigh J, Rance G, Dettman S, Dowell R. Cochlear Implant Outcomes for Children With Auditory Neuropathy Spectrum Disorder. ACTA ACUST UNITED AC 2009. [DOI: 10.1044/hhdc19.2.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractCochlear implantation is currently the intervention option of choice for many children with auditory neuropathy spectrum disorder (ANSD) who are unable to obtain benefit from conventional amplification. The aim of this study was to review the speech perception and language outcomes for children with ANSD who had received a cochlear implant and highlight specific clinical considerations for working with this population of children with hearing impairment who are being considered for implantation. Finds for the group of 17 children with ANSD using cochlear implants were compared to previously reported outcomes for children with sensori-neural (SN) type hearing loss using cochlear implants.Two children, identified with cochlear nerve deficiency pre-operatively, received no useful auditory percepts from their cochlear implant and discontinued device use. The remaining children demonstrated speech perception and language outcomes comparable to those observed for SN hearing loss peers using cochlear implants.This paper highlights a number of considerations for clinicians to be aware of and the importance of careful counseling pre-operatively regarding the potential for less-than-optimal outcomes, particularly for those children identified with cochlear nerve deficiency.
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Affiliation(s)
- Jaime Leigh
- Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital and Department of Otolaryngology, University of MelbourneMelbourne, Australia
| | - Gary Rance
- Department of Otolaryngology, University of MelbourneMelbourne, Australia
| | - Shani Dettman
- Department of Otolaryngology, University of MelbourneMelbourne, Australia
| | - Richard Dowell
- Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital and Department of Otolaryngology, University of MelbourneMelbourne, Australia
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Rance G, Barker EJ. Speech and language outcomes in children with auditory neuropathy/dys-synchrony managed with either cochlear implants or hearing aids. Int J Audiol 2009; 48:313-20. [DOI: 10.1080/14992020802665959] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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