Outcomes and prognostic factors in prelingually sensorineural deaf children with cerebral white matter lesions following cochlear implantation: a multicenter, retrospective study

This study aims to investigate the impact of cerebral white matter lesions (CWMLs) on auditory, speech, and non-verbal cognitive (NVC) outcomes following cochlear implantation (CI) in children with prelingually sensorineural deafness (PLSND) and to identify prognostic factors for these domains. This province-wide retrospective cohort study included PLSND patients with CWMLs undergoing CI, employing propensity score matching for control. Participants were categorized into four groups based on CWMLs severity for auditory, speech, and NVC assessments at various post-CI intervals. Mixed models were used to analyze prognostic factors. In a cohort of 1163 children with PLSND, 15% exhibited CWMLs. CWMLs patients exhibited poorer pre-CI auditory and reduced post-implantation outcomes, correlated with lesion severity. Recovery patterns varied (auditory: rapid-slow; speech: slow-rapid-slow; NVC: rapid-stable), with speech recovery trailing auditory recovery. Greater severity of CWMLs and elevated pre-CI hearing thresholds are risk factors for poorer post-CI auditory and speech outcomes. Conversely, higher income, enhanced pre-CI auditory and NVC capabilities, prolonged rehabilitation, and cesarean delivery are protective factors for these outcomes. Greater severity of CWMLs served as an independent risk factor for post-CI NVC, while cesarean delivery, strong pre-CI speech capabilities, and Advanced Bionics CI device emerged as independent protective factors. This study highlights the importance of incorporating CWMLs severity, perinatal history, and clinical characteristics into preoperative assessments to refine CI candidacy criteria. The identified recovery patterns further guide personalized rehabilitation strategies, contributing to improved long-term outcomes in children with PLSND.