Objective:Children with unilateral hearing loss (UHL) have difficulty hearing in noisy environments and localizing sounds, impacting learning and social opportunities across contexts. Using a visible device like a cochlear implant (CI) may improve functioning but can also create psychological risk. Audiological measures alone are insufficient for predicting social, emotional, educational, adaptive, and quality-of-life post-operative outcomes, which are highly variable in this population and can also be impacted by a secondary diagnosis. Extending beyond audition to consider the “whole child” through neuropsychological evaluation may produce a sharper picture of potential outcomes, with or without surgical/audiological intervention. Given recent FDA approval for CI in children with UHL, more are receiving this elective surgery despite difficulties predicting who will experience significant benefit. Here we describe neuropsychological profiles of children with UHL who underwent CI candidacy evaluation at a tertiary pediatric hospital.Participants and Methods:During pre-operative clinical care, CI candidates completed targeted neuropsychological evaluation to identify patient- and family-level factors that could impact CI use and outcomes from surgery. Cognitive, language, attention/executive, visuoperceptual/visuomotor, academic, adaptive, and emotional/behavioral functioning were assessed. Evaluations integrated history, observations, caregiver report forms, and performance-based test data.Results:18 individuals were evaluated (age 7-months to 16-years). Most had left-sided UHL (67%) and were male (61%). Known hearing loss etiologies were congenital cytomegalovirus (n=5), enlarged vestibular aqueduct (n=1), traumatic brain injury (n=1), meningitis (n=1), cholesteatoma (n=1), neurofibromatosis type 1 (n=1), and Waardenburg syndrome (n=1). Indices of general cognitive ability were generally low average to average. Patterns of cognitive impairment were not restricted to language-based tasks (e.g., Beery VMI-6 range 56-109, M=89.42, SD=16.27). Standardized parent ratings of everyday executive functioning, social/emotional/behavioral functioning, and adaptive skills were collected. Eight (44%) had a behavioral health diagnosis: Attention Deficit Hyperactivity Disorder (n=2), Global Developmental Delay (n=2), Unspecified Neurodevelopmental Disorder (n=2), Autism Spectrum Disorder (n=1), and Depression (n=1). Thirteen (72%) received or will receive a CI, of whom 38% had a behavioral health diagnosis. Average Area Deprivation Index (a marker of socio-economic status) was lower for individuals who ultimately received CIs (M=18%tile) compared to those who did not (M=25%tile).Conclusions:There may be increased rates of neurodevelopmental/psychological conditions among children with UHL, especially when the etiology involves the central nervous system. Albeit preliminary, results align with findings from bilateral hearing loss samples. Findings highlight the importance of routine neuropsychological screening in children with UHL and close interdisciplinary collaboration for optimal outcomes. Socio-economic disparities among those who do and do not receive CI need further exploration as those who did not receive CIs tended to be from less resourced neighborhoods. Additional research is warranted to understand the full range of risk and protective factors for children with UHL and how these relate to outcomes for those who opt for cochlear implantation.

中文翻译：

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70 发现考虑人工耳蜗植入的单侧听力损失儿童的共病神经心理疾病

目的：单侧听力损失 (UHL) 儿童在嘈杂的环境中听力和定位声音有困难，影响跨环境的学习和社交机会。使用人工耳蜗 (CI) 等可见设备可能会改善功能，但也会产生心理风险。仅听力学测量不足以预测术后的社交、情感、教育、适应性和生活质量结果，这些结果在该人群中变化很大，并且也可能受到二次诊断的影响。超越听力，通过神经心理学评估来考虑“整个孩子”，无论有或没有手术/听力干预，都可以对潜在结果产生更清晰的认识。鉴于 FDA 最近批准对 UHL 儿童进行 CI，尽管很难预测谁将获得显着获益，但越来越多的人正在接受这种择期手术。在这里，我们描述了在三级儿科医院接受 CI 候选评估的 UHL 儿童的神经心理学概况。 参与者和方法：在术前临床护理期间，CI 候选者完成了有针对性的神经心理学评估，以确定可能影响 CI 的患者和家庭层面的因素手术的使用和结果。评估了认知、语言、注意力/执行力、视觉知觉/视觉运动、学术、适应性和情感/行为功能。评估综合了病史、观察结果、护理人员报告表和基于表现的测试数据。结果：18 名个体接受了评估（年龄从 7 个月到 16 岁）。大多数患有左侧 UHL (67%)，且为男性 (61%)。已知的听力损失病因包括先天性巨细胞病毒 (n=5)、前庭导水管扩大 (n=1)、创伤性脑损伤 (n=1)、脑膜炎 (n=1)、胆脂瘤 (n=1)、1 型神经纤维瘤病 (n=1) =1) 和瓦登堡综合征 (n=1)。一般认知能力指数普遍较低。认知障碍的模式并不限于基于语言的任务（例如，Beery VMI-6 范围 56-109，M=89.42，SD=16.27）。收集了家长对日常执行功能、社交/情感/行为功能和适应技能的标准化评分。八人 (44%) 进行了行为健康诊断：注意力缺陷多动障碍 (n=2)、整体发育迟缓 (n=2)、未明确的神经发育障碍 (n=2)、自闭症谱系障碍 (n=1) 和抑郁症(n=1)。13 人 (72%) 已接受或将接受 CI，其中 38% 进行了行为健康诊断。最终接受 CI 的个体 (M=18%tile) 的平均面积剥夺指数（社会经济地位的标志）低于未接受 CI 的个体 (M=25%tile)。 结论： UHL 儿童的神经发育/心理状况，特别是当病因涉及中枢神经系统时。尽管是初步的，但结果与双侧听力损失样本的发现一致。研究结果强调了对 UHL 儿童进行常规神经心理学筛查以及密切跨学科合作以获得最佳结果的重要性。接受和未接受 CI 的人之间的社会经济差异需要进一步探讨，因为未接受 CI 的人往往来自资源匮乏的社区。需要进行更多研究来了解 UHL 儿童的全部风险和保护因素，以及这些因素与选择人工耳蜗植入的患者的结果有何关系。