Xiang Mao Ziyue Zhang Yijing Yang Yue Wang Yu Chen Wei Wang ^*

• Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China, Tianjin, China

Cochlear implants (CIs) have the potential to facilitate auditory restoration in deaf children and contribute to the maturation of the auditory cortex. The type of CI may impact hearing rehabilitation in children with CI. We aimed to study central auditory processing activation patterns during speech perception in Mandarin-speaking pediatric CI recipients with different device characteristics.We developed and implemented a multifeature paradigm for Mandarin pronunciation to capture mismatch negativity (MMN) responses in pediatric CI recipients, analyzed the cortical processing sources of MMN responses elicited by different stimuli, and identified significant differences in the frontal cerebral cortex activation between different types of CIs located in the corresponding brain regions according to the Anatomical Automatic Labeling (AAL) brain template.The clinical characteristics, aided hearing threshold (AHT), and speech perception accuracy (SPA) of these children were also recorded.This study involved 32 pediatric CI recipients, with 12 (37.5%) receiving unilateral implants, 10 (31.3%) receiving bilateral implants, and 10 (31.3%) receiving bimodal stimulation. The cortical areas involved in the MMN response to various Mandarin pronunciation stimuli showed the greatest activity in the prefrontal lobe. In children with bimodal stimulation, there was noticeable activation in prefrontal cortical areas. Children with unilateral and bilateral implants also showed activation of the prefrontal cortex, but the activation strength was relatively reduced. The activation of cortical areas did not consistently appear stronger in children with bilateral implants than in those with unilateral implants. Consonant and intensity stimuli showed greater activation, whereas duration and vowel stimuli showed weaker activation. Significant differences in frontal cerebral cortex activation between different types of CIs were predominantly observed in the superior frontal gyrus.Bimodal stimulation should be considered whenever possible to maximize auditory benefits.For deaf children without any residual hearing, bilateral implantation is the best choice. Unilateral implantation is not as detrimental as previously thought for deaf children. Early cochlear implantation, comprehensive auditory training, and better adaptation to CI devices can efficiently compensate for unilateral hearing limitations.