Clinical evaluation of cochlear implantation in children younger than 12 months of age

Importance Cochlear implantation(CI)is an effective therapy for patients with severe to profound sensorineural hearing loss.It remains controversial whether children younger than 12 months of age should undergo CI.Objective To evaluate the safety and effectiveness of CI in children younger than 12 months of age.Methods We performed a retrospective study of clinical data of pediatric patients younger than 12 months of age who underwent CI and were followed up for 1 to 2 years.Patients’developmental levels were evaluated by the Gesell score before CI.Intraoperative and postoperative complications were recorded to evaluate the safety of CI.Auditory and speech abilities were scored by the LittlEARS®auditory questionnaire(LEAQ),categories of auditory performance(CAP),speech intelligibility rating(SIR),infant‐toddler meaningful auditory integration scale(IT‐MAIS),and meaningful use of speech scale(MUSS)at 1,2,3,6,9,and 12 months after CI.The associations between clinical characteristics before CI and postoperative scores at 1 year after CI were analyzed by the linear mixed‐effects model.Results Eighty‐nine children(47 boys and 42 girls)were included in this study(mean age at CI,9.2±1.6 months).Sixteen patients were diagnosed with cochlear malformation and 16 underwent bilateral CI.No severe complications occurred in any patients.The mean developmental quotient of the Gesell score was 78.00±10.03.The median LEAQ scores were 0,5,10,16,22,26 and 30 before and at 1,2,3,6,9,and 12 months after CI,respectively.These findings implied that the LEAQ score greatly improved in the first year after CI.The overall CAP,SIR,IT‐MAIS,and MUSS scores also increased with increasing duration after CI.No significant associations were detected between clinical characteristics(age,sex,implant number,pre‐CI Gesell score,and inner ear malformation)and LEAQ outcomes at 12 months after CI.Interpretation With increasing duration after CI,auditory and speech behavior dramatically improve in young children.Our findings indicate that CI is feasible for children younger than 12 months of age.

Clinical analysis of first branchial cleft anomalies in children

Importance:First branchial cleft anomaly (FBCA) is a rare disease that is difficult to diagnose and is associated with a high rate of complications.However,the difference between two types of FBCA and how to avoid complications are not clear enough.Objective:We retrospectively analyzed type Ⅰ and Ⅱ (Work's classification) FBCAs in children to demonstrate the difference between the two types of FBCAs,especially with respect to understanding the relationship between FBCAs and the facial nerve.Methods:We retrospectively reviewed patients with FBCAs who were treated in Beijing Children's Hospital from 2013 to 2017.The patients' clinical data,relationship of the FBCA with the facial nerve,and postoperative complications were recorded.Results:The study included 70 patients with FBCAs.In total,41 (58.6%) patients had a type Ⅰ FBCA,and 29 (41.1%) had a type ⅡFBCA.A cystic mass was present in 34 (48.6%) patients.Sixty-two (88.6%) patients had a history of incision and drainage and nine (12.8%) had a history of excision surgery in other hospitals.The accuracy rate of magnetic resonance imaging was higher than ultrasound and much higher than computed tomography.Thirtyeight (92.7%) type Ⅰ FBCAs had no close relationship with the facial nerve.The facial nerve in 14 (48.3%) patients with type Ⅱ FBCAs was located superficial to and above the mass.Fifteen (51.7%)type Ⅱ facial nerves were located on the deep side of the mass.All patients in the study had an abnormal external auditory canal (EAC).Three patients had temporary facial palsy that resolved within one week.Eleven patients with type Ⅰ FBCAs had mild EAC stenosis.No recurrence was observed.Interpretation:Type Ⅱ FBCAs had a close relationship with the facial nerve,especially when the lesion was located in the mandible angle.All patients with FBCAs had an EAC abnormality.The abnormal skin and cartilage of the EAC should be excised together to avoid recurrence.