Benefits of Cochlear Implantation and Hearing Preservation for Children With Preoperative Functional Hearing: A Prospective Clinical Trial.

Objectives: This study was designed to (1) compare preactivation and postactivation performance with a cochlear implant for children with functional preoperative low-frequency hearing, (2) compare outcomes of electric-acoustic stimulation (EAS) versus electric-only stimulation (ES) for children with versus without hearing preservation to understand the benefits of low-frequency acoustic cues, and (3) to investigate the relationship between postoperative acoustic hearing thresholds and performance.

Design: This was a prospective, 12-month between-subjects trial including 24 pediatric cochlear implant recipients with preoperative low-frequency functional hearing. Participant ages ranged from 5 to 17 years old. They were recruited at their device activation and fit with EAS or ES based on their postoperative thresholds. Group outcomes were compared for single-word recognition, masked sentence recognition, perceived hearing abilities, speech production, receptive language, expressive language, and prosodic identification.

Results: Children experienced improvements in word recognition, subjective hearing, speech production, and expressive language with EAS or ES as compared with their preoperative abilities. Children using EAS performed better on a prosodic identification task and had higher subjective hearing scores postactivation as compared with children using ES. There was a significant relationship between postoperative thresholds at 125 Hz and prosodic identification.

Conclusions: The results of this study support cochlear implantation for children with normal-to-moderate low-frequency hearing thresholds and severe-to-profound high-frequency hearing loss. They also highlight the benefits of postoperative hearing preservation for language development.