Effects of Sequential Bilateral Cochlear Implantation in Children: Evidence from Speech-Evoked Cortical Potentials and Tests of Speech Perception

Leticia Cristina Vicente, Melissa Jane Polonenko, Karen Ann Gordon, Leandra Tabanez do Nascimento Silva, Orozimbo Alves Costa, Kátia Freitas Alvarenga

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction: Benefits of bilateral cochlear implants (CI) may be compromised by delays to implantation of either ear. This study aimed to evaluate the effects of sequential bilateral CI use in children who received their first CI at young ages, using a clinical set-up. Methods: One-channel cortical auditory evoked potentials and speech perception in quiet and noise were evoked at repeated times (0, 3, 6, 12 months of bilateral CI use) by unilateral and bilateral stimulation in 28 children with early-onset deafness. These children were unilaterally implanted before 3.69 years of age (mean ± SD of 1.98 ± 0.73 years) and received a second CI after 5.13 ± 2.37 years of unilateral CI use. Comparisons between unilaterally evoked responses were used to measure asymmetric function between the ears and comparisons between bilateral responses and each unilateral response were used to measure the bilateral benefit. Results: Chronic bilateral CI promoted changes in cortical auditory responses and speech perception performance; however, large asymmetries were present between the two unilateral responses despite ongoing bilateral CI use. Persistent cortical differences between the two sides at 1 year of bilateral stimulation were predicted by increasing age at the first surgery and inter-implant delay. Larger asymmetries in speech perception occurred with longer inter-implant delays. Bilateral responses were more similar to the unilateral responses from the first rather than the second CI. Conclusion: These findings are consistent with the development of the aural preference syndrome and reinforce the importance of providing bilateral CIs simultaneously or sequentially with very short delays.

Original languageEnglish (US)
Pages (from-to)282-296
Number of pages15
JournalAudiology and Neurotology
Issue number4
StatePublished - Jul 1 2022
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Brazilian Federal Agency for Post-graduate Education (Studentship Funding for LCV, process number: 88881.131618/2016-01).

Publisher Copyright:
© 2022 S. Karger AG, Basel.


  • Bilateral implants
  • Central auditory development
  • Cochlear implants
  • Cortical auditory evoked potentials
  • Speech perception


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