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Children implanted before 2 years of age develop speech and
language at rates that can far exceed those of older implanted
children (Colletti et al. 2005; Dettman et al. 2007; Niparko et
al. 2010). Children implanted before 1 year of age can show
spoken language abilities nearly on par with normal-hearing
peers (Niparko et al. 2010). These studies and others clearly
show the paramount importance of early diagnosis and inter-
vention in the developmental outcome of children with hearing
loss (Colletti 2009).
Results of this study suggest that a bilateral NR ABR is a
strong indicator of progression to CI since every child who
had a NR result on ABR testing during the 5-year observa-
tion period at this institution ultimately received a CI. This is
compelling information for clinicians charged with counseling
therapeutic intervention for children with a NR ABR. Histori-
cally, in our program, referral for a CI evaluation was made
at the time of confirmation of severe to profound hearing loss
with behavioral audiometry, in the present study, on average 6
months from the time of dABR. Thus, referral age for CI for
the youngest children was on average 10 months of age. While
this seems early enough, the outliers in the present study cer-
tainly experienced a number of delays. Similar to previous stud-
ies, significant delays related to the CI process include poor
patient cooperation, developmental or cognitive delays, and
middle ear issues requiring surgical intervention (Lester et al.
2011). Logistical issues such as inefficient transitions between
care providers, poor compliance, and lost to follow-up during
times of diagnostic uncertainty further compound the problem.
The high probability of the NR ABR at indicating progression
to CI could be used to create an increased level of clarity for
families and clinicians during this complex and often emotional
decision-making period. The anticipation of the likely clinical
course of events can possibly obviate some of the typical yet
detrimental delays. The relationship between the NR ABR and
-5
0
5
10
15
0
5
10
15
20
25
30
35
40
Time between ABR and
behavioral testing
Age at ABR (months)
0
5
10
15
20
25
30
0
5
10
15
20
25
30
35
40
Time between behavioral
testing and CI surgery
Age at ABR (months)
0
5
10
15
20
25
30
35
40
0
5
10
15
20
25
30
35
40
Time between ABR and CI
surgery
Age at ABR (months)
r = - 0.335
p = 0.014
r = - 0.052
p = 0.713
r = - 0.593
p = <0.001
Fig. 3. Time course between auditory brainstem response, behavioral testing, and cochlear implantation surgery (in months) versus age at auditory brainstem
response testing. A color version is available online.
161