Interventions for Speech and Language Outcomes for Children with ANSD: A Systematic Review

Purpose or Research Questions: In children with ANSD, how does amplification compared to cochlear implantation affect speech and language outcomes? Background: Auditory Neuropathy Spectrum Disorder, or ANSD is a sensorineural hearing loss characterized by an impairment of the auditory nerve. This generally means that while sound is able to travel through the outer, middle, and inner ear, it is unable to successfully reach the brain. Cochlear Implants (CIs) and hearing aids have both become common interventions for children with ANSD. The purpose of this systematic review is to investigate differences in speech and language outcomes between the two interventions. Methods/Proposed Methods: A literature search was conducted using the following search string: (ANSD OR CND OR Auditory Neuropathy OR Cochlear Nerve Deficiency) AND (children OR pediatric OR school) AND (amplification OR Hearing aids OR hearing amplification OR acoustic stimulation) AND (cochlear implant* OR electric stimulation). Three major databases were searched; PubMed, Ovid, and MedlinePlus. Studies including speech and language outcomes of this population of children were included. Exclusion criteria included children with comorbities, non-English speaking populations, and studies that only considered academic achievement outcomes. 12 studies met the inclusion criteria by addressing one or more of the aspects of our research questions. Eleven of the 12 studies addressed the use of cochlear implantation, and 5 addressed the use of hearing aids. Studies were evaluated for quality using the Cincinnati Children’s LEGEND Appraisal Forms. Data regarding participant, intervention, and outcome variables are reported. Results/Anticipated Results: All studies included were observational in design, including cohort studies and comparisons between children with ANSD and SNHL. The literature supports both hearing aids and CIs as acceptable intervention measures for ANSD. Evidence of favorable outcomes were demonstrated for both types of intervention in children with ANSD. Speech and language outcomes for both the hearing aid subjects and cochlear implant subjects were similar. All participants showed an improved auditory performance to some degree, yet all 12 studies were considered exploratory with methodological limitations and confounding issues. Discussion (e.g., interpretation of results; potential contribution of anticipated results) Due to the wide variety of outcomes for children with ANSD, it is important to identify children who will benefit from amplification and those who are appropriate candidates for cochlear implantation. The clinical evidence determining the differences in speech and language outcomes between CI and HA interventions in the ANSD population is limited. Stronger evidence is needed to demonstrate any important differences in cochlear implant benefit compared to hearing aid benefit as it pertains to speech and language outcomes in children with ANSD