Utility of intraoperative neural response telemetry in pediatric cochlear implants

Objective: The objective of this study is to evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative Threshold (T) and Comfort (C) levels and their correlation over time after cochlear implantation (CI). Methods: A retrospective chart review was conducted of patients less than 18 years of age who had CI with a CochlearTM device and NRT at an academic center from 2010 to 2019. Data collected included demographics, extrapolated NRT threshold (tNRT) and slope of amplitude for electrodes 1, 6/7, 11/12, 16, and 22, and post-operative T and C levels at initial activation and 1 month, 3 months, and 1 year post-activation. Associations between T and C levels and slope of amplitude or tNRT were assessed using Spearman's rank correlation. Results: 39 patients (65 CIs) were included. Intraoperative tNRT correlated strongly with T and C levels at 1 month, 3 months, and 1 year post-activation on nearly all electrodes. Electrodes 6/7 and 11/12 at 3 months and electrodes 6/7 at 1 year did not correlate with T and C levels. There was no significant relationship between the slope of amplitude for nearly all electrodes and the T or C levels post-activation. Conclusion: NRT is invaluable in children, with significant correlation found between tNRT and T and C levels over time on nearly all electrodes. There are changes in T and C levels in electrodes 6/7 and 11/12 over time, and close surveillance is beneficial to tailor programming as needed.