Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl Auditory and language skills in children with auditory brainstem implants Nayara Freitas Fernandes * , Marcos de Queiroz Teles Gomes, Robinson Koji Tsuji, Ricardo Ferreira Bento, Maria Valéria Schimdt Goffi-Gomez Hospital of Clínicas, Faculty of Medicine, University of São Paulo – USP, São Paulo (SP), Brazil ARTICLE INFO Keywords: Auditory brainstem implant Language development Hearing Child Speech perception ABSTRACT Objective: The aim of this study is to characterize the development of auditory and language skills in children during the first 3 years of auditory brainstem implant (ABI) use. Method: It is a retrospective longitudinal analysis of auditory and language skills in 12 children and pre-ado- lescents with pre-lingual deafness following ABI surgery (mean age at surgery: 4 years; age range: 2–11 years). Responses were analyzed aboutInfant Toddler Meaningful Auditory Integration Scale (IT-MAIS), MAIS, and Meaningful Use of Speech Scale (MUSS) at 1, 3, 6, 12, 18, 24, and 36 months after ABI activation. Results: Maximum IT-MAIS/MAIS and MUSS scores after 3 years of ABI use were 45.35% and 35.28%, re- spectively. Conclusion: Pediatric patients exhibit slow progressive development of auditory and language skills following ABI activation. 1. Introduction The formation of new neural connections is critical during ma- turation of the central nervous system, playing a significant role in the development of auditory and language skills in the first years of life. Such connections are influenced by the integrity of the central and peripheral auditory systems [1–4]. Auditory brainstem implants (ABIs) restore peripheral auditory function in individuals with anatomical restrictions, those with neurofibromatosis type II (NF-2), and those with cochlea ossification following meningitis [5–8]. Although ABIs enable access to speech and environmental sounds, the evolution of auditory and language skills in children using ABIs is variable [5,9,10], and not all children achieve the results expected by families in the early years of device use. Wilkinson et al. (2017) described the speech perception of ten children using ABIs between the ages of 2 and 5 years. After 1 year of device use, six children did not respond to ABI, while four children exhibited speech detection thresholds of 30–35 dB HL and were able to discriminate words based on the number of syllables. The authors concluded that ABI surgery and device activation appear to be safe and viable in the pediatric population [11]. Sennaroḡlu et al. (2009) described changes in the auditory behavior of children using ABIs after 15 months of device use. After 3 months of ABI use, six children were able to recognize and discriminate environmental sounds (e.g., bell or phone ringing). At 6 months of ABI use, five children were able to identify Ling's sounds. Within 9 months, two children were able to identify words with different suprasegmental patterns. The authors concluded that the ABI contributed substantially to the development of auditory abilities in these patients [12]. Variability in the efficacy of ABI in pediatric users highlights the necessity to evaluate speech perception in the first years after im- plantation. For cases in which auditory and language development are below the level expected, such assessments of speech perception may help to guide clinicians and caregivers with regard to further treatment and expectations. Therefore, in the present study, the purpose is to characterize the development of auditory and language skills in chil- dren during the first 3 years of ABI use. 2. Method 2.1. Study design In the present study, a retrospective longitudinal analysis of audi- tory and language skills in children using ABI was conducted.at the Hospital of Clinicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). The project was approved by the Ethics and Research Committee of the Faculty of Medicine of the University of São Paulo (FMUSP; protocol number: 673.905/2014). All participants/ https://doi.org/10.1016/j.ijporl.2020.110010 Received 18 October 2018; Received in revised form 15 March 2020; Accepted 15 March 2020 * Corresponding author. Hospital of Clínicas, Faculty of Medicine, University of São Paulo – USP, Dr. Enéas de Carvalho Aguiar Street 255, 6 ° floor, room 6167, São Paulo (SP), 05403-000, Brazil. E-mail address: nayara_freitas_fernandes@yahoo.com.br (N.F. Fernandes). International Journal of Pediatric Otorhinolaryngology 132 (2020) 110010 Available online 16 March 2020 0165-5876/ © 2020 Elsevier B.V. All rights reserved. T