Long-term Change in the Speech Perception Ability in Pediatric Cochlear Implants and the Effect of the Age at Implantation.

OBJECTIVE: We analyzed the long-term changes in speech perception ability of pediatric cochlear implants (CIs) to evaluate the effect of the age at the time of surgery. STUDY DESIGN: Retrospective. SETTING: Tertiary care academic center. PATIENTS: One hundred fourteen prelingually deaf children with CI use duration >10 years. MAIN OUTCOME MEASURES: Categories of auditory performance (CAP) scores and monosyllabic word recognition scores using the Asan-Samsung Korean word list (ASK-WRS) and a conventional word list (KS-WRS) were the main outcomes. Outcomes were compared according to the age at surgery (group I, 1-2 yr; II, 2.1-3 yr; III, 3.1-7 yr; IV, 7.1-13 yr). RESULTS: CAP scores reached plateaus at 2.6 to 3.3 years post-CI; groups I to III showed better scores than group IV. The maximum CAP score was obtained in all children of groups I to III and in 65% of group IV. ASK-WRSs reached plateaus at 3.2 to 4.8 years post-CI. Younger patients at CI operation showed better ASK-WRSs (97, 93, 90, and 54% in groups I-IV, respectively), but the differences were not significant (I versus II and II versus III). Ceiling effect (perfect score) was observed in early groups (67, 44, 30, and 0% in groups I-IV). KS-WRSs, which is a challenging test, reached plateaus at 7.2 to 8.4 years postsurgery with no ceiling effect. Early implantees showed significantly better scores (88, 82, 73, and 46% in groups I-IV). CONCLUSIONS: Speech perception ability after CI showed audiological age-specific improvement evaluated by various test methods. The most challenging test demonstrated long-term performance differences by the age at CI operation.

Speech Perception Growth Patterns in Prelingual Deaf Children With Bilateral Sequential Cochlear Implantation.

OBJECTIVE: To evaluate speech perception following the first (CI-1) and second (CI-2) cochlear implantation (CI) in children with sequential bilateral CI. STUDY DESIGN: Retrospective. PATIENTS: Seventy children with follow-up for 60 months post CI-1 and 36 months post CI-2. MAIN OUTCOME MEASURES: Word recognition score (WRS) was the main outcome. WRSs were compared by age at CI operation (group A ≤ 3.5 yr, B 3.6-8.6, for CI-1; group I ≤ 3.5 yr, II 3.6-7.0, III 7.1-13, IV > 13, for CI-2). RESULTS: For CI-1, the WRS of group A exceeded 80% at 24 months post procedure, earlier than group B (54 mo). Group A also had a shorter period of CI-1 use up to the WRS plateau than group B. CI-2 showed an initial burst of WRS growth much earlier than CI-1. This initial burst was most robust within 3 months in group II, but modest in group IV. The periods of CI-2 use (11-17 mo) up to the WRS plateau were much shorter than CI-1 (40-64 mo). Group I did not show the best WRS at 1 month post CI but later exceeded the other groups. CONCLUSION: Children received an immediate benefit by a burst of WRS growth from CI-2 earlier than CI-1, even within 3 months, suggesting that CI-1 gets the auditory cortex ready to foster speech processing from CI-2. The CI-2 performance depends on age at CI-2 implantation and on CI-1 performance. Our current findings will be relevant for clinicians who are counselling parents on CI-2 surgery.

Prognostic roles of preoperative CT findings and air-bone gaps in type 1 tympanoplasty.

BACKGROUND: Although CT has been used widely, the role of preoperative CT findings including other factors in tympanoplasty has not been elucidated comprehensively. AIMS/OBJECTIVES: To evaluate relationship of CT findings with other factors and audiological results in type 1 tympanoplasty. MATERIAL AND METHODS: A cohort of consecutive 175 patients with type 1 tympanoplasty was enrolled. Addition of mastoidectomy was based on the presence of soft tissue in antrum on CT. Postoperative air-bone gap (ABG) and reperforation rate were analyzed. RESULTS: Positive soft tissue in antrum on CT was found in 52 (29.7%) patients and showed larger preoperative ABG than the negative group. Successful ABG closure (≤20 dB) was obtained in 97% when preoperative ABG ≤20 dB, but it decreased as the preoperative ABG increased (83% with preoperative ABG of 21-30 dB, and 0% with preoperative ABG >30 dB). Postoperative reperforation rate was positively related to the preoperative ABG, but not the presence of soft tissue in the antrum, the size, or locations of preoperative perforations. CONCLUSIONS AND SIGNIFICANCE: Our findings showed that temporal bone CT was helpful in determining addition of mastoidectomy and the presence of soft tissue in the antrum was associated with large ABG.