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Howard W. Francis, MD; Margaret B. Pulsifer, PhD; Jill Chinnici, MA, CCC-A; Robert Nutt; Holly S. Venick, MS, CCC-A; Jennifer D. Yeagle, MS, CCC-A; John K. Niparko, MD

Arch Otolaryngol Head Neck Surg. 2004;130:604-611.

Background  This study explored factors associated with speech recognition outcomes in postmeningitic deafness (PMD). The results of cochlear implantation may vary in children with PMD because of sequelae that extend beyond the auditory periphery.

Objective  To determine which factors might be most determinative of outcome of cochlear implantation in children with PMD.

Design  Retrospective chart review.

Setting  A referral center for pediatric cochlear implantation and rehabilitation.

Subjects  Thirty children with cochlear implants who were deafened by meningitis were matched with subjects who were deafened by other causes based on the age at diagnosis, age at cochlear implantation, age at which hearing aids were first used, and method of communication used at home or in the classroom.

Main Outcome Measure  Speech perception performance within the first 2 years after cochlear implantation and its relationship with presurgical cognitive measures and medical history.

Results  There was no difference in the overall cognitive or postoperative speech perception performance between the children with PMD and those deafened by other causes. The presence of postmeningitic hydrocephalus, however, posed greater challenges to the rehabilitation process, as indicated by significantly smaller gains in speech perception and a predilection for behavioral problems. By comparison, cochlear scarring and incomplete electrode insertion had no impact on speech perception results.

Conclusions  Although the results demonstrated no significant delay in cognitive or speech perception performance in the PMD group, central nervous system residua, when present, can impede the acquisition of speech perception with a cochlear implant. Central effects associated with PMD may thus impact language learning potential; cognitive and behavioral therapy should be considered in rehabilitative planning and in establishing expectations of outcome.

From the Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University, Baltimore, Md (Drs Francis, Pulsifer, and Niparko; Mss Chinnici, Venick, and Yeagle; and Mr Nutt); and the Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Pulsifer). Mr Nutt is now with Dartmouth Medical School, Lebanon, NH. The authors have no relevant financial interest in this article.

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