ABSTRACT
OBJECTIVE: The goal of this report was to ascertain the efficacy of the P1 cortical auditory evoked potential (CAEP) biomarker as an objective tool to assist in the evaluation of cochlear implant (CI) candidacy in children with a radiological diagnosis of cochlear nerve deficiency (CND). METHODS: Retrospective case study review of audiological and radiological findings was performed in four pediatric patients identified with CND and severe-to-profound sensorineural hearing loss. Cortical auditory evoked potential testing was conducted, and the presence and latency of the P1 component were analyzed. RESULTS: Three out of four children demonstrated robust P1 CAEP responses, indicating activation of the central auditory pathways by auditory stimulation, despite the diagnosis of CND. These children were considered good candidates for cochlear implantation. DISCUSSION: Although cochlear implantation in children is a fairly routine procedure, cases exist for which implant candidacy is questionable. Among these cases are children with CND. In these children, cochlear implantation may be contraindicated due to the likelihood that the implant electrodes may not stimulate the VIII nerve adequately. Magnetic resonance imaging (MRI) is considered the gold standard in the assessment of CND, but this measure is not always sufficient to determine CI candidacy in cases of CND. The addition of the P1 CAEP measurement to the usual electrophysiological, audiometric, and radiological test battery may prove to be useful in determining CI options for children with CND.
Subject(s)
Cochlear Nerve/abnormalities , Evoked Potentials, Auditory, Brain Stem , Hearing Loss, Sensorineural/surgery , Age Factors , Audiometry/methods , Biomarkers , Child, Preschool , Female , Follow-Up Studies , Hearing Loss, Sensorineural/diagnosis , Humans , Infant , Magnetic Resonance Imaging/methods , Male , Patient Selection , Retrospective Studies , Risk Assessment , Sampling Studies , Treatment OutcomeABSTRACT
The P1 component of the cortical auditory evoked potential (CAEP) shows clearly documented age-related decreases in latency and changes in morphology in normal hearing children, providing a biomarker for development of the auditory cortical pathways in humans. In hearing-impaired children, auditory deprivation may affect the normal age-related changes in central auditory maturation. Appropriate early intervention with amplification and/or electrical stimulation can provide the necessary stimulation needed to drive progress in central auditory maturation and auditory skill development, however objective measures are needed to evaluate the effectiveness of these treatments in infants and young children. We describe three pediatric cases, where we explored the clinical utility of the P1 as an objective biomarker of auditory cortical development after early intervention. We assessed development of P1 CAEP latency and morphology in two children with sensorineural hearing loss (SNHL) who received intervention with hearing aids (case 1) and cochlear implants (case 2) and a child with Auditory Neuropathy Spectrum Disorder (ANSD) (case 3). Overall, we find that the P1 CAEP serves as useful tool for assessing the effectiveness of early intervention treatment and clinical management of pediatric hearing- impaired patients.
