Language Outcomes in Cochlear Implanted Children with White Matter Disturbances

Document Type : Original

Authors

1 Department of Otolaryngology, New OPD, PGIMER, Sector 12, Chandigarh, India.

2 Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

Introduction: 
The present study reviews our experience with children with white matter disturbances and the benefits they get from rehabilitation post cochlear implantation.
Materials and Methods:
It is a retrospective cohort study of 7 cochlear implanted children with white matter disturbances. Preoperatively all the subjects had undergone a complete Audiological test battery for confirmation of hearing thresholds. Post assessment, a digital hearing aid trial was followed by three months’ therapy. Unilateral cochlear implant surgery and monitored auditory-verbal therapy sessions were the next line of treatment for at least one year. The therapist regularly monitored hearing and communication outcomes on an Auditory verbal ongoing scale, revised CAP, MAIS, word, and sentence discrimination scores.
Results:
The age range of Implantation was between 48 to 60 months. 5 out of 7 participants showed remarkable improvement with regular therapy. Their Meaningful Auditory Integration Scale (MAIS) scores were greater than 35 indicating good auditory integration and Categories of Auditory Performance (CAP) revealed scores of even 9 and higher indicating good telephone conversation. Speech Intelligibility Rating (SIR) showed a rating of 4 meaning thereby that an unfamiliar Listener could understand Speech without additional cues. However, all of them reported difficulty perceiving speech in noisy environments. Two cochlear implantees needed speech reading cues in conjunction with the audition.
Conclusion:
Our experience with cochlear Implantation in children with white matter abnormalities has been positive and satisfactory. The presence of white matter abnormalities on MRI should not be a contraindication for Implantation. Successful outcomes can be expected with regular and dedicated auditory-verbal therapy sessions.

Keywords


  1. Varshney S. Deafness in India. Indian J Otol [Internet]. 2016 [cited 2018 Jul 31];22(2):73. Available from: http://www.indianjotol. org/text. asp? 2016/22/2/73/182281
  2. Wanna GB, Noble JH, Carlson ML, Gifford RH, Dietrich MS, Haynes DS, et al. Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. Laryngoscope [Internet]. 2014 Nov [cited 2018 Jul 31];124(S6): S1–7. Available from: http://www.ncbi.nlm.nih. gov/ pubmed/24764083
  3. Skinner MW, Holden TA, Whiting BR, Voie AH, Brunsden B, Neely JG, et al. In vivo estimates of the position of advanced bionics electrode arrays in the human cochlea. Ann Otol Rhinol Laryngol Suppl [Internet]. 2007 Apr [cited 2018 Jul 31]; 197: 2–24. Available from: http://www.ncbi. nlm.nih. gov/ pubmed/17542465
  4. Kim L-S, Jeong S-W, Huh M-J, Park Y-D. Cochlear Implantation in Children with Inner Ear Malformations. Ann Otol Rhinol Laryngol [Internet]. 2006 Mar 29 [cited 2018 Jul 31]; 115(3): 205–14. Available from: http://www.ncbi. nlm.nih. gov/ pubmed/16572611
  5. Arnoldner C, Baumgartner WD, Gstoettner W, Egelierler B, Czerny C, Steiner E, et al. Audiological performance after cochlear implantation in children with inner ear malformations. Int J Pediatr Otorhinolaryngol [Internet]. 2004 Apr [cited 2018 Jul 31];68(4):457–67. Available from: http://www.ncbi.nlm. nih.gov/ pubmed/15013614
  6. Hammes DM, Novak MA, Rotz LA, Willis M, Edmondson DM, Thomas JF. Early identification and cochlear implantation: critical factors for spoken language development. Ann Otol Rhinol Laryngol Suppl [Internet]. 2002 May [cited 2018 Jul 31]; 189:74–8. Available from: http://www. ncbi. nlm. nih. gov/pubmed/12018355
  7. Papsin BC, Gordon KA. Cochlear Implants for Children with Severe-to-Profound Hearing Loss. N Engl J Med [Internet]. 2007 Dec 6 [cited 2018 Jul 31];357(23):2380–7. Available from: http://www. ncbi. nlm.nih.gov/pubmed/18057340
  8. Pakdaman MN, Herrmann BS, Curtin HD, Van Beek-King J, Lee DJ. Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy. Otolaryngol Neck Surg [Internet]. 2012 Feb[cited 2018 Jul 31];146(2):180–90. Available from: http:// www. ncbi. nlm. nih. gov/ pubmed/ 22140206
  9. Palmieri M, Berrettini S, Forli F, Trevisi P, Genovese E, Chilosi AM, et al. Evaluating Benefits of Cochlear Implantation in Deaf Children With Additional Disabilities. Ear Hear [Internet]. 2012 [cited 2018 Jul 31];33(6):721–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22785571
  10. Perlman JM. White matter injury in the preterm infant: an important determination of abnormal neurodevelopment outcome. Early Hum Dev [Internet]. 1998 Dec 1 [cited 2018 Jul 31];53(2):99–120. Available from: https://www.sciencedirect. com/science/article/pii/S0378378298000371?via%3Dihub
  11. Ahmad H, Cerchiai N, Mancuso M, Casani AP, Bronstein AM. Are white matter abnormalities associated with "unexplained dizziness & quot; ? J Neurol Sci [Internet]. 2015 Nov 15 [cited 2018 Jul 31];358(1–2):428–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26412160
  12. Kristjnsdóttir R, Uvebrant P, Wiklund L-M. Clinical characteristics of children with cerebral white matter abnormalities. Eur J Paediatr Neurol [Internet]. 2000 Jan [cited 2018 Jul 31];4(1):17–26. Available from: http://www.ncbi.nlm.nih. gov/ pubmed/10701100
  13. Geers A, Brenner C, Davidson L. Factors Associated with Development of Speech Perception Skills in Children Implanted by Age Five. Ear Hear [Internet]. 2003 Feb [cited 2018 Jul 31];24 (Supplement): 24S-35S. Available from: http:// www. ncbi.nlm.nih.gov/pubmed/12612478
  14. Martini A, Bovo R, Trevisi P, Forli F, Berrettini S. [Cochlear implant in children: rational, indications and cost/efficacy]. Minerva Pediatr [Internet]. 2013 Jun [cited 2018 Jul 31];65(3):325–39. Available from: http://www.ncbi.nlm. nih.gov/ pubmed/23685383
  15. Busi M, Rosignoli M, Castiglione A, Minazzi F, Trevisi P, Aimoni C, et al. Cochlear Implant Outcomes and Genetic Mutations in Children with Ear and Brain Anomalies. Biomed Res Int [Internet]. 2015 [cited 2018 Jul 31];2015:1–19. Available from: http://www.ncbi. nlm.nih.gov/ pubmed/ 26236732
  16. Trimble K, Rosella{ LC, Propst E, Gordon{ KA, Papaioannou{ V, Papsin BC. Speech Perception Outcome in Multiply Disabled Children following Cochlear Implantation: Investigating a Predictive Score.Journal of the American Academy of Audiology .2008.602-611(19).
  17. Luthra S, Nagarkar A. 1418 Leukodystrophy & Its Effects on Rehabilitation of Children with Cochlear Implant: A Preliminary Case Study. Pediatr Res [Internet]. 2010 Nov 1 [cited 2018 Jul 31];68(S1):701–701. Available from: http:// www. nature. com/ doifinder/ 10.1203 /00006450-201011001 - 01418
  18. McConkey Robbins A, Koch DB, Osberger MJ, Zimmerman-Phillips S, Kishon-Rabin L. Effect of Age at Cochlear Implantation on Auditory Skill Development in Infants and Toddlers. Arch Otolaryngol Neck Surg [Internet]. 2004 May 1 [cited 2018 Jul 31];130(5):570. Available from: http://archotol.jamanetwork.com/article.aspx?doi=10.1001/archotol.130.5.570
  19. Geers AE. Speech, Language, and Reading Skills After Early Cochlear Implantation. Arch Otolaryngol Neck Surg [Internet]. 2004 May 1 [cited 2018 Jul 31];130(5):634. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15148189