Objectives: Our study aimed to identify potential factors that influence rehabilitation outcomes in late-implanted adolescents and adults with prelingual deafness and attempted to develop a reliable nomogram. Design: This retrospective study included 120 subjects less than 30 years of age who had received cochlear implantation at a single medical center. The Categories of Auditory Performance (CAP) scale was used to evaluate the rehabilitation outcomes. A nomogram was constructed using the R and EmpowerStats software. Results: Univariate analysis indicated higher rates of auditory performance improvement in younger aged subjects. Residual hearing and regular and longer implant use were more common among subjects showing auditory performance improvement. Multivariate analysis identified residual hearing (Hazard Ratio, 6.11; 95% Confidence Interval, 1.83-20.41; P<0.01), age at implantation (Hazard Ratio, 0.31; 95% Confidence Interval, 0.14-0.83; P=0.02) and regular CI use (Hazard Ratio, 7.79; 95% Confidence Interval, 2.50-24.20; P<0.01) as independent predictors for auditory performance improvement. The nomogram’s predictive performance was satisfactory as verified by the calibration curve and Receiver operating characteristic (ROC) curve. Conclusions: We demonstrated that residual hearing, younger age, and regular CI use were associated with auditory performance improvement in this cochlear implant user population. Our nomogram model demonstrated satisfactory predictive performance for this population.

Objective: In this study, we aimed to establish a frequency-specific ABR (fs-ABR) system via loudspeakers to assess the hearing improvement in ossiculoplasty intra-operatively and observe its efficiency and accuracy in predicting the long-term outcome. Setting Blackman-gated 1kHz tone-pips with 1ms, 2ms and 3ms duration were used in normal hearing (NH) subjects to calibrate the system and the standard ABR threshold and wave V latency for this system were established. All subjects would take four hearing tests: Pure tone audiometry (PTA) before and six-month after the surgery, fs-ABR under anesthesia before surgery and right after the ossicular chain reconstruction intra-operatively. PTA was used as the standard test to measure hearing. Bland-Altman analysis and linear correlation analysis were used to compare the agreement between PTA and fs-ABR results. Participants Forty-two conductive hearing loss (CHL) subjects. Results: For NH and CHL subjects in operating room before surgery, the fs-ABR threshold showed a high linear relation with the PTA results (r=0.88, P<.0001). For CHL follow up results: for 1ms group, PTAI showed a better correlation with fs-ABRI (r=0.67, P<.01) with the equation: PTAI=2.15*fs-ABRI-3.49; for 3ms group, PTA showed a better correlation with fs-ABR (r=0.76, P<.01) with the equation PTA=0.93*fs-ABR+3.48. Bland-Altman analysis showed no difference between PTA and fs-ABR in all above analysis. Eustachian tube malfunction would negatively affect the prediction efficacy, for subjects with normal ETF, the correlation between fs-ABRI and PTAI was even higher: PTAI=1.6*fs-ABRI+12.48 with r=0.77 (P=.0407<0.05). Conclusions This system could monitor the function of the reconstructed ossicular chain intra-operatively and predict the post-surgical 6-month hearing improvement efficiently and accurately. The average testing time for the fs-ABR was short, about 10 to 15 minutes. This system would serve as a promising tool clinically to help surgeons optimize the efficacy of ossiculoplasty. Besides, ETF should be taken into consideration as a risk factor that would negatively influence the hearing impairment.