Cochlear implantations may improve speech and auditory outcomes in pediatric patients with sensorineural hearing loss: Study

A new study published in The Laryngoscope journal showed that possibilities for cochlear implantation (CI) are growing as research shows benefits in previously thought-inappropriate groups. Sensorineural hearing loss (SNHL) has an uncertain origin and pathophysiology and is the clinical manifestation of cochlear nerve deficit (CND), which is defined as a short or nonexistent cochlear branch of the vestibulocochlear nerve. The patients with congenital SNHL had a 2.5 to 21.2% incidence of CND.

It is challenging to distinguish the CN from other nerves in the internal acoustic meatus (IAM) because of the limits of the present MRI resolution. The use of cochlear implants in patients with CND is still debatable since some research on CI recipients with CND has shown very poor outcomes, while other studies have shown minimal speech discrimination and detection.

Based on MRI results of the IAM's nerves and the CN's size, this research has devised a new IAM nerve grading system and a CN classification system, as follows: Grades 0–III denoted aplasia, which is the observation of 0, 1, 2, and 3 nerve bundles in the IAM. Thereby, Susmita Chennareddy and colleagues undertook this study to investigate the speech and auditory outcomes of CI in young bilateral SNHL patients with radiographically confirmed CND before and after surgery.

The two primary databases (Embase and Ovid MEDLINE) were searched to find pre- and postoperative results of children with CND verified by magnetic resonance imaging who received CI. The variance in speech and auditory outcomes within and across studies was taken into consideration using a random-effects model.

A total of 16 studies, including 248 individuals with cochlear nerve hypoplasia or aplasia who had CI, were added for final inclusion following abstract screening of 818 different papers. The following tests of language development and speech perception were examined in various studies: Categories of Auditory Performance, Auditory Level, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale, Speech Intelligibility Rating, Speech Perception Category and Speech Awareness Thresholds.

After CI, children patients with CND showed improved speech perception, according to pooled results. Overall, as studies show benefits in individuals previously considered unsuitable, the list of indications for CI is growing. In children with bilateral SNHL and CND, this study shows a worldwide improvement in speech and auditory outcomes with CI.

Reference:

Chennareddy, S., Liu, K. H., Mavrommatis, M. A., Kao, D. D., Govindan, A., Schwam, Z. G., & Cosetti, M. K. (2024). Cochlear Implantation in Pediatric Cochlear Nerve Deficiency: A Systematic Review and Meta‐Analysis. In The Laryngoscope. Wiley. https://doi.org/10.1002/lary.31888