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Cochlear Implantation (CI) in Children with ANSD - Coggle Diagram
Cochlear Implantation (CI) in Children with ANSD
Outcomes of CI
Improved Sound Awareness & Speech Perception
Some may show significant improvements, while others may exhibit limited benefit.
Due to the heterogeneous nature of ANSD.
Bypassing the damaged auditory nerve fibers by directly stimulating the auditory nerve.
Providing children with ANSD access to auditory input
Enhance their awareness of environmental sounds and speech stimuli
Language Development
CI support the development of spoken language skills.
Early intervention, consistent auditory habilitation, and supportive educational environments.
Auditory Skills Development
CI facilitate the development of auditory skills.
Sound discrimination, localization, and temporal processing.
Improved QOL
More effective communication.
Increased participation in everyday activities that rely on auditory input.
Educational Progress
Integration into mainstream educational settings.
Enable to access auditory information in the classroom, participate in spoken language instruction, and interact with peers.
Academic performance and social integration.
Challenges of CI
Presence of comorbidity
Eg. hypoxic ischemic encephalopathy causing spastic cerebral palsy, kernicterus with athetoid cerebral palsy
Conditions that can cause speech and language delay from cognitive and oromotor deficits independently from hearing impairment
These co-variables can significantly complicate the assessment of candidacy and outcome of cochlear implantation
NICU graduates are at increased risk of cognitive or motor impairment from brain injury
Limited benefit from CI
Presumably because of a lack of electrical-induced neural synchronization
It is the detrimental effects of their other associated conditions, or a combination of factors
If they have central nervous system pathology
Poor prognosis for the development of speech perception particularly when CND is evident
Postimplantation results in children with postsynaptic ANSD are directly correlated with the lesion location or sites.
Location of the lesion or disturbance in the auditory pathway may affect how well cochlear implantation works
Extent of auditory nerve involvement, existence of neural dysynchrony, general health of auditory nerve fibers
Challenges in speech perception and language development
Eg. neural deficits, auditory processing difficulties, comorbidities
Trouble understanding the auditory signals
Effect of Age at CI on Auditory and Speech Development
Before 24 Months
Auditory Development
81 -100% of children achieved auditory development (Santos et al. 2023)
children implanted before 24 months had higher MAIS and IT-MAIS then children implanted after it (Santos et al. 2023)
Speech Development
showed greater degree of speech improvement (Lee et al. 2021)
After 24 Months
Auditory Development
The development is good, but need more time to achieved the best auditory stages (Lee et al. 2021)
Speech Development
Only 50% of them obatined good speech development (Roush et al. 2011), delayed development (Lee et al. 2021)
CI Candidacy for Children with ANSD
Age
: As early as possible to foster age appropriate speech and language development (3 years and below)
Comprehensive Medical Evaluations
: Neurology, Genetics, and Ophthalmology can provide valuable information to the CI candidacy process given the variability of ANSD presentation (i.e., risk of cognitive impairment, hearing loss etiology, developmental delays).
Minimal Hearing Aid Benefit
: Poor progress with HA or lack of auditory access to speech sounds
Parents' Motivation and vision
: Parents who are highly motivated may pursue cochlear implantation more aggressively than others.
Mode of Communication
: Families who desired spoken language as the primary mode of communication for their child, CIs are viable option for children with ANSD
Audiogram
Laterality:
Bilateral
Configuration of Audiogram:
No specific requirement
Degree of Hearing Loss:
Moderate-to-profound hearing loss
Type of Hearing Loss:
Sensorineural hearing loss
Hearing Thresholds at Different Frequencies:
Average of thresholds at 2kHz, 3kHz & 4kHz ≥75dbHL