Auditory processing disorder in children: the value of a multidisciplinary assessment.

PURPOSE: Auditory processing disorder (APD) may affect 0.2-5% of the paediatric population. The diagnosis of APD remains difficult because of polymorphic symptoms possibly entangled with other difficulties. The purpose of this study was to evaluate a new multi-disciplinary assessment in the French language. METHODS: The battery of tests was composed of: (a) APD targeted speech assessment: speech perception in noise, a dichotic test, temporal processing tests (patterns); (b) Psychometric assessment: sustained auditory attention, sustained visual attention, evaluation of cognitive functions; (c) phonemic identification and discrimination; (d) ENT examination, tonal and vocal audiometry and ABR recordings. The diagnosis was made if two of the targeted speech tests were 2 standard deviations (SDs) below the mean or if only one of the tests was 3 SDs below. The auditory attention tests, as well as the phonemic identification and discrimination tests were complementary to the diagnostic battery. However, they did not allow for the diagnosis of APD. RESULTS: 50 children suspected of APD benefited from this protocol, and 12 were excluded from the study. A diagnosis of APD was confirmed in 17 children (45%). 59% of the patients had associated disorders. The most effective tests for diagnosing APD were dichotic testing (p = 0.001) and pattern recognition (frequency, p = 0.001). The sustained auditory attention test (p = 0.01) and the phonemic identification and discrimination test reinforced the diagnosis of APD. CONCLUSION: It seems important to evaluate children suspected of APD with a multi-disciplinary protocol. It makes it possible to diagnose APD children, but also to identify attentional difficulties and cognitive disorders that may be associated.

Cochlear implant failure and revision surgery in pediatric population.

OBJECTIVE: This study aimed to report pediatric cochlear reimplantation data focusing on failure of the device and to assess surgical challenges and functional outcomes. METHODS: Retrospective case review from 1990 to 2012. Tertiary referral academic center. A retrospective review of medical and surgical records, audiologic results, and report of the manufacturer's analysis was performed. The causes of revision cochlear implantation were divided into hard failure and soft failure. Results compared speech perception in open set or closed set words before and after revision surgery with cochlear implant only. RESULTS: During the study period, 877 cochlear implantations were performed. Our reimplantation rate for failure of the device is 5.7% (50 of 877). The main reasons for hard failure were loss of hermeticity and cracked casing following head trauma. Surgical difficulties might be due to neo-osteogenesis related to the use of bone dust. Initial atraumatic insertion is important to ensure that revision surgeries are less problematic. In postmeningitis deafness, initial choice of electrode array is of utmost importance. We would suggest a plain shape and a larger diameter array, to ensure sufficient subsequent insertion. Post-reimplantation audiologic results were the same or better than preoperative levels in 86% of cases. CONCLUSION: Failure might be difficult to diagnose in children with limited language skills. The surgical team and patients should be aware of the surgical difficulties that can be encountered, especially in cases of meningitis or initial traumatic insertion. Auditory performances after reimplantation are the same or better in most cases.