The functional status of central neural pathways, in particular their susceptibility to plasticity and functional reorganization, may influence speech performance of deaf cochlear implant users. In this paper, we sought to determine how brain metabolic activity measured before implantation relates to cochlear implantation outcome, that is, speech perception. In 22 prelingually deaf children between 1 and 11 years, we correlated preoperative glucose metabolism as measured by F-18 fluorodeoxyglucose positron emission tomography with individual speech perception performance assessed 3 years after implantation, while factoring out the confounding effect of age at implantation. Whereas age at implantation was positively correlated with increased activity in the right superior temporal gyrus, speech scores were selectively associated with enhanced metabolic activity in the left prefrontal cortex and decreased metabolic activity in right Heschl's gyrus and in the posterior superior temporal sulcus. These results reinforce the notion that implantation should be performed as early as possible to prevent cross-modal takeover of auditory regions and suggest that rehabilitation strategies may be more efficient if they capitalize on general cognitive functions instead of only targeting specialized circuits dedicated to auditory and audiovisual pattern recognition.

No death was attributed to device implantation. Major complications included: device failure in 12 patients, misplaced electrodes in 4, hematoma in 3, flap necrosis in 3, magnet displacement in 2, facial nerve twitching in 2, electrode exposure in 2, external auditory canal keratoma in 1, immediate facial nerve paralysis in 1, and skin flap irritation due to the suture material in 1. The overall major complication rate was 4.2% (30/720), and there were 37 minor complications (5.1%), which were resolved by conservative treatment or minor intervention. Minor complications included temporary vertigo in 17 patients, facial twitching in 11, hematoma in 4, subcutaneous emphysema in 3, and temporary facial nerve paralysis in 2.

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