title: Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes.
abstract: OBJECTIVE
  To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation.
  
  
  METHODS
  Prospective multicenter cohort study.
  
  
  METHODS
  Six tertiary referral centers.
  
  
  METHODS
  Children 5 years or younger before implantation with normal nonverbal intelligence.
  
  
  METHODS
  Cochlear implant operations in 209 ears of 188 children.
  
  
  METHODS
  Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores.
  
  
  RESULTS
  Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up.
  
  
  CONCLUSIONS
  Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287-0910, USA. hfrancis@jhmi.edu
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
authors.forename: Craig A
authors.initials: CA
authors.lastname: Buchman
authors.forename: Jiovani M
authors.initials: JM
authors.lastname: Visaya
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Zwolan
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
mesh_terms: D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects; D003054:Cochlear Implants; D015331:Cohort Studies; D004566:Electrodes; D005260:Female; D034381:Hearing Loss / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007804:Language Development; D007807:Language Tests; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D013067:Speech Perception; D016896:Treatment Outcome