TY - JOUR
T1 - Stimulation rate reduction and auditory development in poorly performing cochlear implant users with auditory neuropathy
AU - Pelosi, Stanley
AU - Rivas, Alejandro
AU - Haynes, David S.
AU - Bennett, Marc L.
AU - Labadie, Robert F.
AU - Hedley-Williams, Andrea
AU - Wanna, George B.
PY - 2012/12
Y1 - 2012/12
N2 - OBJECTIVE: Patients with auditory neuropathy spectrum disorder (ANSD) exhibit altered neural synchrony in response to auditory stimuli. It has been hypothesized that a slower rate of electrical stimulation in programming strategies for cochlear implant (CI) users with ANSD may enhance development of neural synchrony and speech perception abilities. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otologic practice. PATIENTS: Twenty-two patients with ANSD underwent CI. Patients with complete postoperative audiometric data and at least 2 years of follow-up were included in further analysis. INTERVENTION: Thirteen patients patients met inclusion criteria. Five "poorly performing" CI recipients with ANSD who had not developed closed-set speech perception abilities despite at least 2 years of implant use underwent implant programming to lower the neural stimulation rate. MAIN OUTCOME MEASURES: Speech perception abilities over time using parent questionnaire, closed-set testing, and open-set measures. RESULTS: A high incidence of comorbid conditions was present in the poor performers, including cognitive delay (n = 2), motor delay (n = 3), and autism spectrum disorder (n = 1). The median time to rate slowing in 5 poor performers was 29 months after implant activation. Three of 5 patients achieved closed-set speech perception scores higher than 60% after 6 to 16 months of implant use at the slower rates. At last follow-up (median, 42 mo), no poor performer had yet achieved open-set speech perception abilities. Of all CI recipients with ANSD included in analysis, open-set speech perception abilities developed in 46% (6/13). CONCLUSION: In CI recipients with ANSD who demonstrate limited auditory skills development despite prolonged implant use, lowering the stimulation rate may facilitate acquisition of closed-set speech perception abilities. Further efforts on the study of programming parameters in ANSD patients with CIs are necessary to maximize auditory development in this patient population.
AB - OBJECTIVE: Patients with auditory neuropathy spectrum disorder (ANSD) exhibit altered neural synchrony in response to auditory stimuli. It has been hypothesized that a slower rate of electrical stimulation in programming strategies for cochlear implant (CI) users with ANSD may enhance development of neural synchrony and speech perception abilities. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otologic practice. PATIENTS: Twenty-two patients with ANSD underwent CI. Patients with complete postoperative audiometric data and at least 2 years of follow-up were included in further analysis. INTERVENTION: Thirteen patients patients met inclusion criteria. Five "poorly performing" CI recipients with ANSD who had not developed closed-set speech perception abilities despite at least 2 years of implant use underwent implant programming to lower the neural stimulation rate. MAIN OUTCOME MEASURES: Speech perception abilities over time using parent questionnaire, closed-set testing, and open-set measures. RESULTS: A high incidence of comorbid conditions was present in the poor performers, including cognitive delay (n = 2), motor delay (n = 3), and autism spectrum disorder (n = 1). The median time to rate slowing in 5 poor performers was 29 months after implant activation. Three of 5 patients achieved closed-set speech perception scores higher than 60% after 6 to 16 months of implant use at the slower rates. At last follow-up (median, 42 mo), no poor performer had yet achieved open-set speech perception abilities. Of all CI recipients with ANSD included in analysis, open-set speech perception abilities developed in 46% (6/13). CONCLUSION: In CI recipients with ANSD who demonstrate limited auditory skills development despite prolonged implant use, lowering the stimulation rate may facilitate acquisition of closed-set speech perception abilities. Further efforts on the study of programming parameters in ANSD patients with CIs are necessary to maximize auditory development in this patient population.
KW - Auditory neuropathy
KW - Cochlear implant
KW - Neural stimulation rate
KW - Programming strategy
KW - Speech perception
UR - http://www.scopus.com/inward/record.url?scp=84870380227&partnerID=8YFLogxK
U2 - 10.1097/MAO.0b013e31826bec1e
DO - 10.1097/MAO.0b013e31826bec1e
M3 - Article
C2 - 22972423
AN - SCOPUS:84870380227
SN - 1531-7129
VL - 33
SP - 1502
EP - 1506
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 9
ER -