COCHLEAR IMPLANTATION OF CHILDREN WITH MINIMAL OPEN-SET SPEECH RECOGNITION SKILLS

Objective The purpose of this study was to evaluate the postoperative performance of 12 children who demonstrated some open-set speech recog nition skills before receiving a Nucleus multichannel cochlear implant with a view toward expanding the selection criteria for cochlear impl ant candidacy to include children who derive minimal benefit from ampl ification. Design: Pre- and postoperative performance of two groups of children were compared. Group 1 consisted of 12 children who demonstr ated some open-set speech recognition skills before receiving a Nucleu s multichannel cochlear implant (Borderline group) Group 2 consisted o f 12 children who demonstrated no open-set speech recognition skills b efore implantation with a Nucleus device (Traditional group). In all c hildren, candidacy was determined based on preimplant binaural aided p erformance, For most subjects, the poorer ear was selected for implant ation. Mean pre and postoperative speech recognition scores of the Bor derline subjects were compared to determine the benefit provided by th eir cochlear implants, Secondly, matched-pair analyses were used to co mpare the mean speech recognition scores obtained by the Borderline an d Traditional subjects. Results: The scores of the Borderline group im proved significantly on five of six speech recognition measures when 6 mo postoperative scores obtained with the implant were compared with preoperative test scores obtained with hearing aids. By the 12 mo post operative interval, the scores of the Borderline group had improved si gnificantly (p < 0.05) on all six measures. In contrast, scores obtain ed by the Traditional group had improved significantly on three of six measures at both the 6 and 12 mo postoperative intervals. Comparison of postoperative test scores revealed that the Borderline group scored significantly higher than the Traditional group on three of six measu res at the 6 mo test interval and on six of six measures at the 12 mo test interval (p < 0.05). Conclusions: The findings of this study indi cate that both groups derive significant benefit from their cochlear i mplants. Although the mean preoperative audiograms for the implanted e ars did not differ significantly for the two groups of subjects, membe rs of the Borderline group exhibited significantly better speech recog nition skills than the Traditional group during the first year after i mplantation. These findings suggest that, the increased auditory exper ience of the Borderline subjects positively influenced their performan ce with a cochlear implant, The authors advocate that the selection cr iteria used to determine pediatric cochlear implant candidacy be broad ened to include consideration of children who demonstrate minimal open -set speech recognition skills.