Electrical stimulation from a cochlear implant can spread beyond the auditory nerve. The aims of ... more Electrical stimulation from a cochlear implant can spread beyond the auditory nerve. The aims of this study were to accurately measure facial nerve stimulation in pediatric implant users and to determine the characteristics and incidence of this unwanted activity. Part A consisted of a prospective study of a randomized sample of 44 pediatric implant users. Part B consisted of a retrospective analysis of 121 children with previously recorded electrically evoked auditory brainstem responses (EABR). Responses were evoked by 3 electrodes along the implant array in three groups of children: 1) postmeningitic, 2) abnormal cochlea, and 3) neither. Intraoperative measures were obtained under anesthesia; all other recordings were completed in awake children. Intraoperative recordings revealed large nonauditory responses in a number of channels, including the midline EABR. Under paralysis, these responses disappeared, and clear EABRs were recorded. Similarly, prospective postoperative electro...
International journal of pediatric otorhinolaryngology, 2000
Cochlear implants have enabled many children with severe to profound sensorineural hearing loss t... more Cochlear implants have enabled many children with severe to profound sensorineural hearing loss to develop speech perception skills. However, some children experience few gains while others develop high levels of speech perception. We identified potential factors contributing to poor performance with an implant by studying implanted children who do not develop functional speech perception. Five children were identified as developing no open-set word recognition skills after at least 2 years of implant use. This study group was compared to a randomly selected control group (n=10) and an age-matched control group (n=5). Pre-implant factors were examined using a Graded Profile Analysis and post-implant factors were assessed in a retrospective chart review. A greater number of pre-implant concerns were raised in the study group than in randomized controls (P<0.01). Chronological age and duration of deafness were pre-implant concerns in all study group subjects. A greater number of po...
Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and pro... more Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;binaural fusion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing.
The Annals of otology, rhinology & laryngology. Supplement, 2002
Input to the central auditory system through a cochlear implant promotes psychophysical improveme... more Input to the central auditory system through a cochlear implant promotes psychophysical improvement of auditory skills. However, the developmental changes along the pathways have never been characterized in children with hearing loss who use implants. We aimed to measure auditory development in such children by using the electrically evoked auditory brain stem response (EABR). We made repeated measures of the EABR in 41 nonsedated children with implants before chronic stimulation and after 2, 6, and 12 months of consistent implant use. The results show that EABRs were present in all of the children even before chronic auditory stimulation, and that EABR wave latencies decreased from the time of initial activation throughout the first year of cochlear implant use. These findings reflect auditory development to the level of the midbrain as a result of the cochlear implant. The decreasing latencies likely reflect decreased neural conduction times at this level, in part because of incre...
Children require audible and comfortable stimulation from their cochlear implants immediately aft... more Children require audible and comfortable stimulation from their cochlear implants immediately after device activation. To accomplish this, a battery of objective measures may be needed that could include the electrically evoked stapedius reflex (ESR), compound action potential from the auditory nerve (ECAP), and/or auditory brain stem response (EABR). In the present study, the following specific research questions were asked: In children using cochlear implants, 1) Can the ECAP, EABR, and ESR be recorded at the time of cochlear implantation? 2) What is the feasibility of measuring the ECAP, EABR, and the ESR repeatedly without the use of sedation over the first year of implant use? 3) Do ECAP, EABR, and ESR thresholds or behavioral measures change over time? 4) What is the relation between ECAP, EABR, and ESR thresholds and behavioral measures of threshold and comfortably loud levels? In 68 children, ECAP, EABR, and ESR responses as well as behavioral measures of stimulation thresho...
International journal of pediatric otorhinolaryngology, 2012
Cochlear implantation is a successful method of auditory rehabilitation. This procedure has been ... more Cochlear implantation is a successful method of auditory rehabilitation. This procedure has been associated with facial nerve and vestibular end-organ stimulation suggesting potential for extra-cochlear stimulation. The objectives of this study were to investigate the potential relationship between cochlear implantation and seizure activity in the pediatric implant population. Local Research Ethics Board approval was obtained. The Hospital for Sick Children's Cochlear Implant Database from 1998 to 2011 was retrospectively reviewed. Based on a multidisciplinary team, patients who received a diagnosis of seizure disorder or had been investigated for seizure-like activity were identified and reviewed. Fifteen children from a group of 816 pediatric cochlear implant users were identified as having suspected seizure-like activity. Eventually 10 children were found to have seizures based on an evaluation by a pediatric neurologist and an electroencephalogram. Of these 10, only 3 childr...
Although voice has been studied extensively in children who use cochlear implants (CIs), speech p... more Although voice has been studied extensively in children who use cochlear implants (CIs), speech production has not been studied in this population using the Motor Speech Profile. Whether children who receive CIs gain normal speech production abilities is unknown. To assess speech and articulation in deaf, long-term CI users who had undergone early unilateral cochlear implantation, compared with their normal-hearing peers. Cross-sectional study at a tertiary pediatric hospital of 16 children aged 8 to 17 years who had undergone early implantation, are longstanding users, and had excellent audiogram and speech perception scores. Results were compared with a historical pediatric normal-hearing group. Unilateral cochlear implantation. The Motor Speech Profile, an objective method for assessing motor speech in children. The CI users had normal articulation and timing but poorer than normal intonation stimulability, particularly frequency variability. Diadochokinesis rates were within the 95% confidence interval of age-matched pediatric norms for 11 of 16 (69%) and 11 of 15 (73%) children with CI when they were performing /pa/ and /pataka/ tasks, respectively. The magnitude and rate of the second formant transitions were within normal limits for 9 of 16 (56%) and 10 of 12 (83%) children, respectively. The variability in frequency and amplitude of intonation stimulability domains were within normal limits for 7 of 16 (44%) and 16 of 16 (100%) children, respectively. The syllabic rate and duration were both within normal limits for 14 of 16 children (88%). Despite significant improvements in speech after cochlear implantation, abnormalities remain, particularly in frequency variability. Such deviations can present as a decreased expression of emotion in speech and likely reflects decreased auditory frequency resolution provided by the CI. These deficits have been the focus of ongoing work to advance CI technologies and speech-processing strategies.
Assess vestibular and balance function in meningitis-induced profound sensorineural hearing loss ... more Assess vestibular and balance function in meningitis-induced profound sensorineural hearing loss (SNHL). Prospective cohort study. Tertiary pediatric referral center. Nine pediatric participant with profound SNHL after bacterial meningitis with (8) and without (1) unilateral Cochlear implant. Horizontal canal function in response to caloric and high-frequency rotation (0.25-5 Hz). Saccular function assessed by the vestibular evoked myogenic potential. Static and dynamic balance performance on the balance subset of the Bruininsk-Oseretsky Test of Motor Proficiency 2. Labyrinthine ossification on computed tomography preimplant, with follow-up imaging in a subset (n = 7). Horizontal canal function in response to caloric stimulation was abnormal in all children, with 5 of 8 demonstrating bilateral areflexia and 3 of 8 having asymmetric hypofunction with better function on the implanted side. In response to rotation, horizontal canal function was abnormal in all but 1 child (8 of 9). Saccular function, assessed by VEMP, was intact in most of the children (5 of 7). Static and dynamic balance (Bruininsk-Oseretsky Test of Motor Proficiency 2 scores) were significantly poorer in the meningitis group compared with both normal-hearing controls (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and children with SNHL of variable etiology and Cochlear implant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Labyrinthine ossification was present in all cases, with variable extent, location, and progression. Vestibular function and balance are compromised in children with SNHL after meningitis. Whereas vestibular loss seems well compensated at low frequency through an overreliance on visual inputs, deficits surface during high-frequency rotation, particularly in dark. Saccular function seems less susceptible to damage from meningitis. Extent, location, and progression of ossification were variable. Despite profound dysfunction on objective testing, subjective limitations in functional balance were not reported, demonstrating the significant ability of children to compensate for even the most severe vestibular losses.
Journal of the American Academy of Audiology, 2008
Children with multiple disabilities account for a small percentage of implantees in a cochlear im... more Children with multiple disabilities account for a small percentage of implantees in a cochlear implant program, but they remain the most challenging group for which to predict benefit from the implant and for cooperation with habilitation postoperatively. To assess the relationship of pre-implant functional disabilities with postoperative speech perception scores and determine the feasibility of predicting outcome with a cochlear implant in a multiply disabled pediatric population. Retrospective cohort study. Sixty-six children with a cochlear implant and at least one additional disability. We retrospectively examined the relationship between pre-implant Graded Profile Analysis (GPA) scores and postimplant speech perception scores. A pre-implant functional disability score (based on the Battelle developmental screen) was applied to the same cohort of patients and its association with postimplant speech perception scores was examined. The functional disability score significantly predicted high (k &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 24) and low (k &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 7) speech perception scores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and had excellent discrimination ability (c statistic = 0.88 and 0.93 respectively). The GPA score was not significantly associated with speech perception scores (p = 0.519 and p = 0.146) and demonstrated no ability to discriminate postimplant speech perception scores in this implant population (c statistic = 0.49 and c = 0.57). Prediction of outcomes following cochlear implantation in multiply disabled children can be facilitated using this newly developed functional disability score as an adjunct to traditional candidacy assessments.
Electrical stimulation from a cochlear implant can spread beyond the auditory nerve. The aims of ... more Electrical stimulation from a cochlear implant can spread beyond the auditory nerve. The aims of this study were to accurately measure facial nerve stimulation in pediatric implant users and to determine the characteristics and incidence of this unwanted activity. Part A consisted of a prospective study of a randomized sample of 44 pediatric implant users. Part B consisted of a retrospective analysis of 121 children with previously recorded electrically evoked auditory brainstem responses (EABR). Responses were evoked by 3 electrodes along the implant array in three groups of children: 1) postmeningitic, 2) abnormal cochlea, and 3) neither. Intraoperative measures were obtained under anesthesia; all other recordings were completed in awake children. Intraoperative recordings revealed large nonauditory responses in a number of channels, including the midline EABR. Under paralysis, these responses disappeared, and clear EABRs were recorded. Similarly, prospective postoperative electro...
International journal of pediatric otorhinolaryngology, 2000
Cochlear implants have enabled many children with severe to profound sensorineural hearing loss t... more Cochlear implants have enabled many children with severe to profound sensorineural hearing loss to develop speech perception skills. However, some children experience few gains while others develop high levels of speech perception. We identified potential factors contributing to poor performance with an implant by studying implanted children who do not develop functional speech perception. Five children were identified as developing no open-set word recognition skills after at least 2 years of implant use. This study group was compared to a randomly selected control group (n=10) and an age-matched control group (n=5). Pre-implant factors were examined using a Graded Profile Analysis and post-implant factors were assessed in a retrospective chart review. A greater number of pre-implant concerns were raised in the study group than in randomized controls (P<0.01). Chronological age and duration of deafness were pre-implant concerns in all study group subjects. A greater number of po...
Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and pro... more Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;binaural fusion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing.
The Annals of otology, rhinology & laryngology. Supplement, 2002
Input to the central auditory system through a cochlear implant promotes psychophysical improveme... more Input to the central auditory system through a cochlear implant promotes psychophysical improvement of auditory skills. However, the developmental changes along the pathways have never been characterized in children with hearing loss who use implants. We aimed to measure auditory development in such children by using the electrically evoked auditory brain stem response (EABR). We made repeated measures of the EABR in 41 nonsedated children with implants before chronic stimulation and after 2, 6, and 12 months of consistent implant use. The results show that EABRs were present in all of the children even before chronic auditory stimulation, and that EABR wave latencies decreased from the time of initial activation throughout the first year of cochlear implant use. These findings reflect auditory development to the level of the midbrain as a result of the cochlear implant. The decreasing latencies likely reflect decreased neural conduction times at this level, in part because of incre...
Children require audible and comfortable stimulation from their cochlear implants immediately aft... more Children require audible and comfortable stimulation from their cochlear implants immediately after device activation. To accomplish this, a battery of objective measures may be needed that could include the electrically evoked stapedius reflex (ESR), compound action potential from the auditory nerve (ECAP), and/or auditory brain stem response (EABR). In the present study, the following specific research questions were asked: In children using cochlear implants, 1) Can the ECAP, EABR, and ESR be recorded at the time of cochlear implantation? 2) What is the feasibility of measuring the ECAP, EABR, and the ESR repeatedly without the use of sedation over the first year of implant use? 3) Do ECAP, EABR, and ESR thresholds or behavioral measures change over time? 4) What is the relation between ECAP, EABR, and ESR thresholds and behavioral measures of threshold and comfortably loud levels? In 68 children, ECAP, EABR, and ESR responses as well as behavioral measures of stimulation thresho...
International journal of pediatric otorhinolaryngology, 2012
Cochlear implantation is a successful method of auditory rehabilitation. This procedure has been ... more Cochlear implantation is a successful method of auditory rehabilitation. This procedure has been associated with facial nerve and vestibular end-organ stimulation suggesting potential for extra-cochlear stimulation. The objectives of this study were to investigate the potential relationship between cochlear implantation and seizure activity in the pediatric implant population. Local Research Ethics Board approval was obtained. The Hospital for Sick Children's Cochlear Implant Database from 1998 to 2011 was retrospectively reviewed. Based on a multidisciplinary team, patients who received a diagnosis of seizure disorder or had been investigated for seizure-like activity were identified and reviewed. Fifteen children from a group of 816 pediatric cochlear implant users were identified as having suspected seizure-like activity. Eventually 10 children were found to have seizures based on an evaluation by a pediatric neurologist and an electroencephalogram. Of these 10, only 3 childr...
Although voice has been studied extensively in children who use cochlear implants (CIs), speech p... more Although voice has been studied extensively in children who use cochlear implants (CIs), speech production has not been studied in this population using the Motor Speech Profile. Whether children who receive CIs gain normal speech production abilities is unknown. To assess speech and articulation in deaf, long-term CI users who had undergone early unilateral cochlear implantation, compared with their normal-hearing peers. Cross-sectional study at a tertiary pediatric hospital of 16 children aged 8 to 17 years who had undergone early implantation, are longstanding users, and had excellent audiogram and speech perception scores. Results were compared with a historical pediatric normal-hearing group. Unilateral cochlear implantation. The Motor Speech Profile, an objective method for assessing motor speech in children. The CI users had normal articulation and timing but poorer than normal intonation stimulability, particularly frequency variability. Diadochokinesis rates were within the 95% confidence interval of age-matched pediatric norms for 11 of 16 (69%) and 11 of 15 (73%) children with CI when they were performing /pa/ and /pataka/ tasks, respectively. The magnitude and rate of the second formant transitions were within normal limits for 9 of 16 (56%) and 10 of 12 (83%) children, respectively. The variability in frequency and amplitude of intonation stimulability domains were within normal limits for 7 of 16 (44%) and 16 of 16 (100%) children, respectively. The syllabic rate and duration were both within normal limits for 14 of 16 children (88%). Despite significant improvements in speech after cochlear implantation, abnormalities remain, particularly in frequency variability. Such deviations can present as a decreased expression of emotion in speech and likely reflects decreased auditory frequency resolution provided by the CI. These deficits have been the focus of ongoing work to advance CI technologies and speech-processing strategies.
Assess vestibular and balance function in meningitis-induced profound sensorineural hearing loss ... more Assess vestibular and balance function in meningitis-induced profound sensorineural hearing loss (SNHL). Prospective cohort study. Tertiary pediatric referral center. Nine pediatric participant with profound SNHL after bacterial meningitis with (8) and without (1) unilateral Cochlear implant. Horizontal canal function in response to caloric and high-frequency rotation (0.25-5 Hz). Saccular function assessed by the vestibular evoked myogenic potential. Static and dynamic balance performance on the balance subset of the Bruininsk-Oseretsky Test of Motor Proficiency 2. Labyrinthine ossification on computed tomography preimplant, with follow-up imaging in a subset (n = 7). Horizontal canal function in response to caloric stimulation was abnormal in all children, with 5 of 8 demonstrating bilateral areflexia and 3 of 8 having asymmetric hypofunction with better function on the implanted side. In response to rotation, horizontal canal function was abnormal in all but 1 child (8 of 9). Saccular function, assessed by VEMP, was intact in most of the children (5 of 7). Static and dynamic balance (Bruininsk-Oseretsky Test of Motor Proficiency 2 scores) were significantly poorer in the meningitis group compared with both normal-hearing controls (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) and children with SNHL of variable etiology and Cochlear implant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Labyrinthine ossification was present in all cases, with variable extent, location, and progression. Vestibular function and balance are compromised in children with SNHL after meningitis. Whereas vestibular loss seems well compensated at low frequency through an overreliance on visual inputs, deficits surface during high-frequency rotation, particularly in dark. Saccular function seems less susceptible to damage from meningitis. Extent, location, and progression of ossification were variable. Despite profound dysfunction on objective testing, subjective limitations in functional balance were not reported, demonstrating the significant ability of children to compensate for even the most severe vestibular losses.
Journal of the American Academy of Audiology, 2008
Children with multiple disabilities account for a small percentage of implantees in a cochlear im... more Children with multiple disabilities account for a small percentage of implantees in a cochlear implant program, but they remain the most challenging group for which to predict benefit from the implant and for cooperation with habilitation postoperatively. To assess the relationship of pre-implant functional disabilities with postoperative speech perception scores and determine the feasibility of predicting outcome with a cochlear implant in a multiply disabled pediatric population. Retrospective cohort study. Sixty-six children with a cochlear implant and at least one additional disability. We retrospectively examined the relationship between pre-implant Graded Profile Analysis (GPA) scores and postimplant speech perception scores. A pre-implant functional disability score (based on the Battelle developmental screen) was applied to the same cohort of patients and its association with postimplant speech perception scores was examined. The functional disability score significantly predicted high (k &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 24) and low (k &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 7) speech perception scores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and had excellent discrimination ability (c statistic = 0.88 and 0.93 respectively). The GPA score was not significantly associated with speech perception scores (p = 0.519 and p = 0.146) and demonstrated no ability to discriminate postimplant speech perception scores in this implant population (c statistic = 0.49 and c = 0.57). Prediction of outcomes following cochlear implantation in multiply disabled children can be facilitated using this newly developed functional disability score as an adjunct to traditional candidacy assessments.
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