Cochlear implantation in children with congenital X-linked deafness due to novel mutations in POU3F4 gene.
OBJECTIVE
We report novel mutations in the POU3F4 gene resulting in congenital X-linked deafness DFN3, and describe the results of cochlear implantation in 4 boys (3 siblings) followed for an average of 3.5 years.


METHODS
The diagnosis of DFN3 was made in infant boys on the basis of the radiologic criteria of an underdeveloped modiolus, a wide cochlear fossette, and the presence of all cochlear turns. The POU3F4 gene was sequenced. A standard, transmastoid, facial recess approach was used for cochlear implantation. A lumbar drain was placed before the operation.


RESULTS
The identified mutations in the POU3F4 gene were novel (p.R167X in the 3 siblings) or recently reported (p.S310del). A high-flow cerebrospinal fluid leak through the cochleostomy was encountered in each patient and was ultimately controlled. Although the implants functioned properly, the auditory perceptual abilities did not progress past sound detection in the 3 siblings, or past closed-set word identification in the non-sibling, who achieved better speech perception with contralateral amplification. Three boys (2 siblings) show signs of other learning disorders; 1 boy was too young for a complete assessment.


CONCLUSIONS
Preoperative gene mutation analysis in DFN3 patients who are considering cochlear implantation may help in long-term counseling and in avoidance of postoperative complications. Limited auditory perception and language acquisition may result. Amplification may sometimes be a better alternative than cochlear implantation, despite the severity of the hearing loss.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114-3096, USA.
Konstantina M
KM
Stankovic
Ann Marie
AM
Hennessey
Barbara
B
Herrmann
Leila A
LA
Mankarious
D001299:Audiometry; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects; D003638:Deafness / Q000151:congenital / Q000235:genetics* / Q000503:physiopathology / Q000601:surgery*; D040181:Genetic Diseases, X-Linked / Q000235:genetics*; D006801:Humans; D007223:Infant; D008297:Male; D009154:Mutation; D050809:POU Domain Factors / Q000235:genetics*
D050809:POU Domain Factors; C091774:POU3F4 protein, human