Auditory and speech function after cochlear implantation in prelingually deaf children with white matter lesions

: FUNCAO AUDITIVA E DE FALA APOS IMPLANTE COCLEAR EM CRIANCAS SURDAS PRE-LINGUAGEM COM LESOES DA SUBSTÂNCIA BRANCA: OBJETIVO: Explorar como a funcao auditiva e da fala se desenvolveu pos implante coclear (pIC) em criancas surdas pre-linguagem com lesoes da substância branca (LSB). METODO: Pacientes (41 do sexo masculino, 29 do sexo feminino; media de idade no implante 2a 11m [DP 7,5m], variacao 1a 8m-5a) foram divididos nose seguintes grupos de acordo com a avaliacao da imagem de ressonância magnetica pre-operatoria: LSB leve, LSB moderada, LSB severa, e controle. Avaliamos o desempenho auditivo e de fala na linha de base, 6 meses, 12 meses, e 24 meses, pCI. Tambem foram registrados e analisados potenciais auditivos relacionados a eventos, mapas topograficos e imagem de fontes de eletroencefalorafia 24 meses pIC. RESULTADOS: Para criancas com LSB (qualquer nivel), o desempenho auditivo e de fala pos-operatorio aos 6 meses foi significantemente abaixo dos participantes controle. Apos estratificacao, o desempenho se relaciou fortemente com o grau de LSB. O desempenho auditivo e de fala nos grupos com LSB leve e controle foi comparativamente melhor do que nos grupos LSB moderado e severo. A taxa de recuperacao do desempenho da fala ficou atras da percepcao auditiva. Com a maior severidade da LSB, a amplitude N1 foi significativamente menor, com apresentacao consistente no mapa topografico, que foi similar nos grupos LSB leve e controle. O centro auditivo dominante estava ativado nos grupos controle e LSB leve, mas nao nos grupos com LSB moderada e grave. INTERPRETACAO: A LSB gradualmente afeta o desenvolvimento auditivo e de fala, e o desempenho eletrofisiologico pIC em criancas surdas pre-linguagem. METHOD: Patients (41 males, 29 females; mean age at implantation 2y 11mo [SD 7.5mo], range 1y 8mo-5y) were divided into the following groups according to preoperative brain magnetic resonance imaging evaluation: mild WML, moderate WML, severe WML, and control. We assessed auditory and speech performance at baseline, 6 months, 12 months, and 24 months pCI. As well as auditory event-related potentials, topographic maps and electroencephalography source imaging were recorded and analysed at 24 months pCI. RESULTS: For children with WML (any level), postoperative auditory or speech performance at 6 months was significantly below that of control participants. After stratification, auditory and speech performance was highly related to WML grading. Auditory or speech performance in mild WML or control groups was comparatively better than the moderate WML and severe WML groups. The recovery rate of speech performance fell behind that of the auditory perception. With the increasing severity of WML, N1 amplitude was significantly smaller with a consistent presentation in the topographic map, which was similar in the mild WML and control group. The dominant auditory centre was activated in the control or mild WML groups, but not in the moderate WML and severe WML groups. INTERPRETATION: WML gradually affect auditory and speech development, and electrophysiological performance pCI in prelingually deaf children. WHAT THIS PAPER ADDS: Auditory and speech performance in prelingually deaf children with white matter lesions (WML) was significantly worse than those without WML. Postoperative auditory and speech performance in children with WML was highly related to WML grading. Grand N1 amplitude in auditory event-related potentials was negatively related to the severity of WML. Non-dominant areas close to the auditory cortex were potentially activated in severe WML.