title: Initial Results With Image-guided Cochlear Implant Programming in Children.
abstract: OBJECTIVE
  Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients.
  
  
  BACKGROUND
  CIs have been highly successful for children with severe-to-profound hearing loss, offering potential for mainstreamed education and auditory-oral communication. Despite this, a significant number of recipients still experience poor speech understanding, language delay, and, even among the best performers, restoration to normal auditory fidelity is rare. Although significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. Recently introduced techniques for image-guided CI programming (IGCIP) permit creating patient-customized CI programs by making it possible, for the first time, to estimate the position of implanted CI electrodes relative to the nerves they stimulate using CT images. This approach permits identification of electrodes with high levels of stimulation overlap and to deactivate them from a patient's map. Previous studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs.
  
  
  METHODS
  The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 mo to 13 yr) and ranged in age from 5 to 17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map.
  
  
  RESULTS
  Using a two-tailed Wilcoxon signed-rank test, statistically significant improvement (p < 0.05) was observed for word and sentence recognition in quiet and noise, as well as pediatric self-reported quality-of-life (QOL) measures.
  
  
  CONCLUSIONS
  Our results indicate that image guidance significantly improves hearing and QOL outcomes for pediatric CI recipients.
authors.affiliation: *Department of Electrical Engineering and Computer Science, Vanderbilt University †Department of Hearing and Speech Science ‡Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: Jack H
authors.initials: JH
authors.lastname: Noble
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Hedley-Williams
authors.forename: Linsey
authors.initials: L
authors.lastname: Sunderhaus
authors.forename: Benoit M
authors.initials: BM
authors.lastname: Dawant
authors.forename: Robert F
authors.initials: RF
authors.lastname: Labadie
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Camarata
authors.forename: René H
authors.initials: RH
authors.lastname: Gifford
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003051:Cochlea / Q000000981:diagnostic imaging*; D019929:Cochlear Implantation / Q000379:methods; D003054:Cochlear Implants; D005260:Female; D006309:Hearing; D006801:Humans; D007223:Infant; D007802:Language; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012984:Software; D014057:Tomography, X-Ray Computed