AGE AT IMPLANTATION AND AUDITORY PERFORMANCE OF PRELINGUAL POPULATION. N= 146 Age range: 0-49 y. CC Pearson:

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1 Auditory Critical Period for Unilateral and Bilateral Cochlear Implantation AGE AT IMPLANTATION AND AUDITORY PERFORMANCE OF PRELINGUAL POPULATION N= 146 Age range: 0-49 y CC Pearson: p<

2 Vision Auditory cortex Cortex Auditory-Visual Cro oss-m moda al pla asticity Cochlea C. I. DISYLLABIC WORDS % Bisy yllabic wo ords y 1 8y 1 8y 1 8y 1 8y 0-3 y 4-6 y 7-10 y y > 14 y Follow-up Age at implantation

3 Results age by age What are the limits of the auditory criticalperiod? 279 Children with a prelingual profound bilateral hearing loss. No ossifications, no cochlear malformations, full insertion of the electrodes. GROUPS Age N

4 Disyllabic Words Presentation: 65dBSPL SPL, opencontext ords abas bras yllabic Bisíla wo % Palab Disy Chronological Age ( years) ) Age Disyllabic Words Presentation: 65 db SPL, open context ds labic wor % Disyll There is a significative ifi correlation between results and age of implantation. Early is better! Chronological Age ( years) Age

5 100 Disyllabic Words Presentation: 65 db SPL, open context ds labic wor % Disyll Only children implanted before 6 years of age achieve levels in an open set speech perception Chronological Age ( years) Age Disyllabic Words Presentation: 65 db SPL, open context ds labic wor % Disyll Only children implanted before 3 years of age improve along the time Chronological Age ( years)) Age

6 100 Disyllabic Words Presentation: 65 db SPL, open context ds labic wor % Disyll Crhonological Age ( years ) Age Conclusions The auditory stimulation with a cochlear implant must be initiated during the 3 first years of life. After 6 years of age unilateral cochlear implantation does not permit to achieve high levels of open-set speech recognition Early implantación is better.

7 Sound localization Head shadow effect Better discrimination in noise Bilateral stimulation of a developing auditory system

8 Program UN 102 Bilateral l Dec 2008 Demographics N= 38 4 years follow-up Adults Children 1st 2nd 86 Sequential Simultaneus Mean:2.16 years Range: 1-9 years Mean:7.34 years Range: 3-15 years

9 Mean: 4.92 years SD: 1.69 years Method 2nd Disyllabic words 65dB SPL Disyllabic words, 65dB SPL without visual support

10 Disyllabic words, 65 db 2nd CC: p<0.05 1st : Mean age at implantation 2.16 years Critical period for the 2nd : 8 years of age 2002-Dec Stimulation of the auditory system from one ear does not promote the complete development of the auditory system in children suffering from a congenital hearing loss The results obtained with the ear implanted in the second place are not comparable to those of the first ear, even after four years of follow up. 90 Disylla bic wor ds p< p< st 2nd % Mean age of 1st 2.16 y (SD 1.61) Mean age of 2nd 7.34 y (SD 2.88) Chronological age (years) 2002-Dec 2008

11 The binaural benefit in sequential cochlear implantation Method 1st 2nd Disyllabic words 65dB SPL Disyllabic words, 65dB SPL without visual support

12 Disyllabic words, 65 db p<0.05 p<0.001 Binaural benefit 2002-Dec 2008 Method 1st 2nd Sentences, 65dB SPL without visual support S/N +10 db

13 Sentences, 65 db Noise -10 db p<0.01 p<0.01 Binaural benefit 2002-Dec 2008 SSQ questionnaire for parents Section II: Sound localization p< 0.05 Better results in Bilateral group

14 In sequential cochlear implantation, does the time gap from the first till the second implant influence: - the binaural benefit? Disyllabic words, 65 db CC= p< <

15 Disyllabic words, 65 db CC= p< 0.01 Disyllabic words, 65 db CC= p< 0.05

16 CONCLUSIONS There is a critical period for the second ear implantation and the potential binaural benefit obtained with bilateral s. We estimate such critical period for the second ear ends around 8 to 10 years of age. Binaural benefits are evident through a bilateral cochlear implantation when it s performed into the auditory critical period. Actually, systematically we propose to the parents a simultaneous bilateral cochlear implantation.

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