ORIGINAL ARTICLE Blink reflex and auditory speech perception in prelingually cochlear-implanted children HESSAMEDDIN EMAMDJOMEH 1,2 , LIDA SHAFAGHAT 1,2 , PARVANEH ABBASSALIPOUR 1 , SAEED HASSANZADEH 1 , FARSHID ALAEDDINI 3 , MOHAMMAD FARHADI 1,2 & AHMAD DANESHI 1,2 1 Iran Cochlear Implant Center, 2 ENT, Head & Neck Surgery Research Center, Rassoul-Akram Hospital, Iran University of Medical Sciences, and 3 National Research Center of Medical Sciences, Tehran, Iran Abstract Conclusion . The results of this study show that R  / prelingually cochlear-implanted children are not optimal candidates for cochlear implantation. However, if this group are implanted, other rehabilitation methods should be incorporated into their rehabilitation program in order to achieve better results and maximize the efficacy of their prosthesis. Objective . To demonstrate that the blink reflex or auropalpebral reflex evaluation can be used as a prognostic factor for the assessment of auditory and speech perception levels in prelingually cochlear-implanted children. Material and methods . In an observa- tional, analytical, prospective study conducted at a single cochlear implant rehabilitation center in 85 prelingually cochlear- implanted children, the presence or absence of the blink reflex (BR) was evaluated and the results of auditory and speech perception tests were compared between reflex-positive (R /) and reflex-negative (R  /) patients. To obtain the BR, four electrodes were applied in both the Nucleus and MED-EL systems and then stimulated by means of current levels higher than the previously detected most comfortable level of the patient until the reflex appeared. Auditory and speech perception levels were measured using the vowels-confusion test and the categorization of auditory perception scale. Results . The mean results of auditory and speech perception tests were significantly higher in R / compared to R  / patients. Keywords: Brainstem, central information processing, cochlear implant, prognostic factor, reflex-negative Introduction The blink reflex (BR) is a brief closing of the eyelids by involuntary contraction of the orbicularis oculi muscle, which is innervated by the anterior motor fibers of the temporal branch and zygomatic branch of the facial nerve. It is a brainstem reflex and can be triggered by photic, acoustic or electrical stimula- tion. Since its first electromyographic recordings by Kugelberg in 1952 [1], the BR has become the most widely used electrophysiological test of brain stem function [2  /4]. The results of a study undertaken by Marx et al. [5] underline the high localizing value of changes in the R1 component of the BR in patients with ipsilateral pontine functional deficits [5]. In addition, the BR can disclose subclinical lesions in the medulla oblongata which are not detected by brainstem auditory-evoked potentials alone [6]. Measurement of the BR has many uses in otology, e.g. as a simple screening method for neonatal hearing loss or as a substitute for the stapedial reflex in cases of middle ear effusion. Recent research carried out by neuropsychologists suggests that the BR is a useful tool for investigating information processing by the central nervous sys- tem, as well as for the early detection of cognitive deficits in preterm infants. Some measurement techniques exploiting infrared sensors yield reliable data with neonates as young as 12 h old [7]. There is evidence to suggest that the speed of information processing, as measured by means of the inspection and reaction times, may be the underlying factor on which differences in intelligence are based [8]. Moreover, it was suspected that the speed of information processing would affect the facilitation and inhibition of the BR [9]. Early results using the Correspondence: Hessameddin Emamdjomeh, N. 39, Shaafeh St., Mellat Autobank, Dr. Shariatti Ave., 16617, Tehran, Iran. Tel:  /98 21 2841949. Fax:  /98 21 6739916. E-mail: I_CI_C@yahoo.com Acta Oto-Laryngologica, 2005; 125: 358  /362 (Received 5 July 2004; accepted 9 September 2004) ISSN 0001-6489 print/ISSN 1651-2551 online # 2005 Taylor & Francis DOI: 10.1080/00016480410024596