Factors contributing to limited or non-use in the cochlear implant systems in children: 11 years experience § Su ¨ leyman O ¨ zdemir a, *, U ¨ lku ¨ Tuncer a , O ¨ zgu ¨r Tarkan a , Mete Kırog ˘lu a , Fikret C ¸etik a , Funda Akar b a C ¸ukurova University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Adana, Turkey b C ¸ukurova University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Audiology and Speech Disorders, Adana, Turkey 1. Introduction Cochlear implant (CI) is a surgically implanted electronic device that provides audiological rehabilitation to a person who is profoundly hearing impaired deaf and who derives insufficient benefit from conventional hearing aids [1,2]. Although older children and adult patients are able to decide whether or not wear the external part on their own, smaller children’s family must force the child to use the device. CI system is a very expensive procedure so the candidates for surgery and their families should be chosen very carefully. There are a lot of studies about cochlear implants published in the literature. On the other hand very few of them are related to the non-use or limited use of implants [3–5]. As a term, ‘‘limited use’’ is used for the recipients who were used the implant for fewer than 2 h in the awaken times of a day and ‘‘non-use’’ is used for complete rejection of usage of implant [3]. In the current study, we aimed to evaluate the incidence and etiologic factors of non-use and limited use in the children’s long- term use of cochlear implants. The patients’ age, gender, duration of implantation, additional disabilities and auditory performances were investigated. 2. Subjects and methods We were investigated 462 patients who had undergone cochlear implantation surgery in the C ¸ukurova University School of Medicine, Department of Otorhinolaryngology between January 2000 and December 2011, 12 limited user/non-user cochlear implanted patients were selected who had an age under 16 and had a follow-up of at least 24 months. Listening progress profile (LiP) and Meaningful Auditory Integration Scale (MAIS) tests were selected from the evaluation of auditory responses to speech (EARS) test protocol to analyze the auditory performances of the patients [6]. International Journal of Pediatric Otorhinolaryngology 77 (2013) 407–409 A R T I C L E I N F O Article history: Received 25 September 2012 Received in revised form 26 November 2012 Accepted 29 November 2012 Available online 29 December 2012 Keywords: Cochlear implant Non-user Limited user Additional disabilities Autism A B S T R A C T Objectives: The aim of this study was to analyze the incidence and etiologic factors of non-use and limited use of cochlear implants. The patients’ age, gender, duration of implantation and additional disabilities were investigated. Patients and methods: Of the 413 (200 males, 213 females) pediatric patients (age under 16) implanted in our clinic between January 2000 and December 2011, 12 limited user/non-user cochlear implanted patients were selected who had a follow-up of at least 24 months. Preoperative and postoperative listening progress profile (LiP) and meaningful auditory integration scale (MAIS) tests were performed to analyze the auditory performances of the patients. Results: In total of 12 recipients (2.90%) (7 male and 5 female patients; age range, 5–13 years), 4 (0.96%) patients were non-users and 8 (1.93%) patients were limited users. The patients had some additional disabilities as autism, cerebral palsy, moderate mental retardation, attention deficit/hyperactivity disorder, ossified cochlea due to meningitis and learning disability-lack of family interest. None had experienced device failure. In the postoperative 24th month, listening progress profile and meaningful auditory integration scale test scores were better in the limited users as expected. Conclusions: It should always be considered in patients with additional factors like autism, mental- motor retardation, learning disabilities that they will show limited development from cochlear implantation. These patients are potential limited/non-users. These patients require unique rehabilita- tion and provide high family and educational interest. ß 2012 Elsevier Ireland Ltd. All rights reserved. § Presented at the 11th International Congress of the European Society of Pediatric Otorhinolaryngology (ESPO 2012); Amsterdam, Netherlands, May 20–23, 2012. * Corresponding author at: C ¸ukurova University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Adana 01100, Turkey. Tel.: +90 322 3386639; fax: +90 322 3386527. E-mail address: drsozdemir@gmail.com (S. O ¨ zdemir). Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l 0165-5876/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2012.11.041