2015 HSC Section 1 Book of Articles

HANG ET AL. / EAR & HEARING, VOL. 36, NO. 1, 8–13

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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.

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

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

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