Stimulation rate reduction and auditory development in poorly performing cochlear implant users with auditory neuropathy

摘要

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.