Cochlear implantation in children with enlarged vestibular aqueducts

Objectives: This report details our experience with cochlear implantation in children with both profound sensorineural HL (SNHL) and enlarged vestibular aqueducts (EVAs), It seeks to determine if the abnormal anatomy of EVA predisposes to any adverse events during or after cochlear implantation. Study Design: A retrospective review. Methods: Charts were reviewed for details of the procedure, complications, and audiologic outcome. Results: Between 8/25/93 and 9/16/98, 10 children with EVAs received cochlear implants, of whom 8 children (5 males, 3 females; mean age 7.8 y) had audiologic follow-up of at least 6 months. The implant was inserted without difficulty in all patients. Pulsatile clear fluid via the cochleostomy was observed in five patients, but was easily controlled in each instance. There have been no major complications, although two patient had short-lived postoperative vestibular symptoms and one child has experienced an intermittent pulsing sensation in her head. Speech perception measures were obtained using a battery of tests that assessed the children's ability to perceive speech in both open- and closed-set formats. Two patients were excluded because the implant was placed within the last 6 months. Of the remaining eight children identified with EVAs, seven (86%) demonstrated open-set word recognition. Conclusions: These favorable results may be attributed in part to HL that occurs relatively late in childhood, allowing implantation in postlingual candidates. Cochlear implantation can be safely and effectively performed in children with SNHL associated with EVAs.