The impact of cochlear and cochlear nerve development on long-term outcomes of cochlear implantation in children with cochlear nerve deficiency
Objective To investigate the impact of cochlear types and the developmental status of the vestibulocochlear nerve on auditory and speech outcomes and the rate of auditory speech development in children with cochlear nerve deficiency(CND)after cochlear implantation(CI).Methods The auditory and speech outcomes of CND children were assessed before CI and within five years post-operation with the Categories of Auditory Performance(CAP)and Speech Intelligibility Rating(SIR)questionnaires.Children were categorized by cochlear type into common cavity(CC),cochlear hypoplasia(CH),incomplete partition(IP),and normal cochlea(NC)groups.They were also grouped by the number of nerve bundles in the internal auditory canal into CND Ⅰ,Ⅱ,Ⅲ,and Ⅳ groups(nerve bundles 1,2,3,and 4,respectively).With generalized estimating equations(GEE),auditory speech outcomes were compared among different cochlear types and vestibulocochlear nerve development levels both pre-CI and within five years post-activation.Kaplan-Meier survival analysis was used to evaluate the auditory and speech development with CAP=5 and SIR=3 as event endpoints.Results Except for the statistically significant differences in CAP and SIR scores between the CC and NC groups 5 years after CI surgery,there are no statistically significant differences in CAP and SIR scores before CI surgery and within 5 years post-activation among CND children with different cochlear types.The rate of auditory and speech development also showed no significant differences among these groups.Among CND children with varying degrees of vestibulocochlear nerve development,there were no significant differences in CAP and SIR scores before CI,but significant differences were observed among most groups within 5 years post-operation.The rate of auditory and speech development showed significant differences among these groups.Conclusions The development level of the vestibulocochlear nerve was a key factor in determining both the short-term and long-term auditory speech outcomes and the rate of speech development in children with CND after CI.The presence and type of cochlear malformation did not directly impact the post-operative outcomes in CND children.
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