Health-related quality of life of Austrian children and adolescents with cochlear implants

Factors impacting outcomes of cochlear implantation in children at two University centres in China: Multi-year analysis from the Paediatric Implanted Recipient Observational Study (P-IROS)

OBJECTIVES

To identify factors affecting functional hearing performance and quality of life (QoL) outcomes in paediatric cochlear implantation (CI) recipients at two University centres in mainland China.

METHODS

Two university centres in mainland China, part of the prospective longitudinal Paediatric Implanted Recipient Observational Study (P-IROS), contributed participant data. Participants were aged under 10 years at time of CI. Functional hearing performance and QoL measures were collected prior to device activation, and at 6-monthly intervals for 2 years post-implantation. Functional hearing endpoints including Categories of Auditory Performance-II (CAP-II) and QoL were evaluated and analysed using ordinal mixed-effects regression models.

RESULTS

Data were from 288 children with a mean age at implant of 2.74 years. Overall follow-up at 1 year was 59% and 51% at 2 years. Younger age at implantation (p<0.001) and hearing aid use preimplantation (p=0.026) were associated with significant benefit. Bilateral device users (both CI and bimodal) achieved significantly better functional hearing performance on the CAP-II than unilateral CI users (p<0.001). Slower functional hearing improvements were observed in those with lower parental expectations compared to higher expectations (p<0.001). QoL improved over time but followed a different initial trajectory between centres.

CONCLUSION

All participants demonstrated significant improvements in auditory performance and QoL over time. Younger age at CI, and bilateral/bimodal device fitting contributed to earlier improvements. Other potential factors that could help inform families, professionals, and health authorities about choice of hearing device and educational supports required included aetiology of hearing loss and level of maternal education.

Deaf Identity, Social Relationships, and Social Support: Toward a Microsociological Perspective

This study is the first to analyze data from a national survey to investigate the significance for deaf identity of the different forms of social and technological support that deaf people rely upon. Data were derived from a survey among 839 deaf people and were analyzed with regard to social identification as deaf, hearing, bicultural, and marginal. Findings showed connections between technology and identity, including the use of a range of technology to support being culturally deaf. Findings also showed that the deaf and hearing groups had strong homophilous social networks, while the bicultural group tended toward more mixed but equally strong social connectivity. The marginal group had a much thinner social connectivity and relied more upon institutional social support, findings that are in line with previous research revealing a sub-group struggling with social participation and well-being. Theoretically, the paper builds bridges between the fields of social identity and microsociology and shows how a microsociological perspective brings attention to the significance of reiterated social relations and practice for constructing social identity.

Validity, Discriminative Ability, and Reliability of the Turkish Hearing-Related Quality of Life Questionnaire for Children and Adolescents

PURPOSE

The aim of this study was to translate the versions of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) into Turkish and investigate the validity and reliability of the Turkish 26-item HEAR-QL (HEAR-QL-26) for children and Turkish 28-item HEAR-QL (HEAR-QL-28) for adolescents.

METHOD

The protocol included translation into Turkish and linguistic adaptation. The HEAR-QL-26 and HEAR-QL-28, respectively, were administered to 249 children (130 with hearing loss, 119 without hearing loss) and 249 adolescents (140 with hearing loss, 109 without hearing loss) between the ages of 8 and 18 years. To determine the internal consistency (reliability) of the Turkish HEAR-QL scale, Cronbach's alpha coefficient (α) was calculated for the subcategories and the total score. We measured the construct validity of the Turkish HEAR-QL-26 and HEAR-QL-28 using Pearson r correlation coefficients comparing the Turkish HEAR-QL and the Turkish Child and Adolescent Quality of Life Scale (PedsQL).

RESULTS

The reliability for both children and adolescents (Cronbach's alpha = .973 for HEAR-QL-26 and .977 for HEAR-QL-28) was high, and test-retest reliability showed strong to excellent correlations (intraclass correlation coefficient = .980 and .979, respectively) for the total scores. In terms of known-group validity, the total HEAR-QL mean scores were lower for participants with hearing loss than for children/adolescents with normal hearing (p < .05). Confirmatory factor analysis showed that the number of original items was sufficient in the Turkish version. Both HEAR-QL versions provided a higher area under the curve (AUC = .984 and .972, respectively) than the PedsQL (AUC = .773 and .581, respectively).

CONCLUSION

The Turkish versions of the HEAR-QL-26 child and HEAR-QL-28 adolescent questionnaires are sensitive, reliable, and valid measurement tools to evaluate the hearing-related quality of life in children and adolescents aged between 8 and 18 years.

Speaking Rate, Immediate Memory, and Grammatical Processing in Prelingual Cochlear Implant Recipients

PURPOSE

This study examined the extent to which prelingual cochlear implant (CI) users show a slowed speaking rate compared with typical-hearing (TH) talkers when repeating various speech stimuli and whether the slowed speech of CI users relates to their immediate verbal memory.

METHOD

Participants included 10 prelingually deaf teenagers who received CIs before the age of 5 years and 10 age-matched TH teenagers. Participants repeated nonword syllable strings, word strings, and center-embedded sentences, with conditions balanced for syllable length and metrical structure. Participants' digit span forward and backward scores were collected to measure immediate verbal memory. Speaking rate data were analyzed using a mixed-design, repeated-measures analysis of variance, and the relationships between speaking rate and digit spans were evaluated by Pearson correlation.

RESULTS

Participants with CIs spoke more slowly than their TH peers during the sentence repetition task but not in the nonword string and word string repetition tasks. For the CI group, significant correlations emerged between speaking rate and digit span scores (both forward and backward) for the sentence repetition task but not for the nonword string or word string repetition task. For the TH group, no significant correlations were found.

CONCLUSIONS

The findings indicate a relation between slowed speech production, reduced immediate verbal memory, and diminished language capabilities of prelingual CI users, particularly for syntactic processing. These results support theories claiming that immediate memory, including components of a central executive, influences the speaking rate of these talkers. Implications for therapies designed to increase speech fluency in CI recipients are discussed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21644795.

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants–not just cochlear implant-specific benefits–Perspective

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8–9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Parent-reported quality of life in children with cochlear implants differs across countries

Pediatric cochlear implantation affects communication skills and quality of life, specifically how children interact with others and feel about themselves. Numerous studies worldwide examine well-being among pediatric cochlear implant users, but none to date compare condition-specific quality of life across countries. This retrospective study compares parent-reported cochlear implant-specific quality of life summary data across 14 published studies spanning 11 countries and 9 languages. Sample size ranged from 7 to 370 participants, and children across studies varied in mean chronologic age (3.1–12.2 years), implantation age (1.5–4.6 years), and cochlear implant experience (1.3–8.2 years). Parents completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) questionnaire, an instrument assessing parent-reported cochlear implant-specific quality of life, in their home language. Analysis of variance tests were run for each CCIPP subscale across studies using summary data to determine significant differences between published manuscripts. Across countries, parents of children with cochlear implants appraise communication, social relations, and self-reliance most positively, and the effects of implantation and supporting the child least positively. Cross-country analyses revealed a significant effect of study (country) on quality of life ratings in each domain, with the largest differences in the communication domain. Limited access to implant-related accommodations, cultural awareness of hearing loss, and varying parent expectations may explain country differences in parental ratings of quality of life. Culturally sensitive psychoeducation for the entire family may foster improved life satisfaction for pediatric cochlear implant users and their families.

Enhancing socio-emotional communication and quality of life in young cochlear implant recipients: Perspectives from parameter-specific morphing and caricaturing

The use of digitally modified stimuli with enhanced diagnostic information to improve verbal communication in children with sensory or central handicaps was pioneered by Tallal and colleagues in 1996, who targeted speech comprehension in language-learning impaired children. Today, researchers are aware that successful communication cannot be reduced to linguistic information—it depends strongly on the quality of communication, including non-verbal socio-emotional communication. In children with cochlear implants (CIs), quality of life (QoL) is affected, but this can be related to the ability to recognize emotions in a voice rather than speech comprehension alone. In this manuscript, we describe a family of new methods, termed parameter-specific facial and vocal morphing. We propose that these provide novel perspectives for assessing sensory determinants of human communication, but also for enhancing socio-emotional communication and QoL in the context of sensory handicaps, via training with digitally enhanced, caricatured stimuli. Based on promising initial results with various target groups including people with age-related macular degeneration, people with low abilities to recognize faces, older people, and adult CI users, we discuss chances and challenges for perceptual training interventions for young CI users based on enhanced auditory stimuli, as well as perspectives for CI sound processing technology.

Parameter-Specific Morphing Reveals Contributions of Timbre to the Perception of Vocal Emotions in Cochlear Implant Users

Objectives:

Research on cochlear implants (CIs) has focused on speech comprehension, with little research on perception of vocal emotions. We compared emotion perception in CI users and normal-hearing (NH) individuals, using parameter-specific voice morphing.

Design:

Twenty-five CI users and 25 NH individuals (matched for age and gender) performed fearful-angry discriminations on bisyllabic pseudoword stimuli from morph continua across all acoustic parameters (Full), or across selected parameters (F0, Timbre, or Time information), with other parameters set to a noninformative intermediate level.

Results:

Unsurprisingly, CI users as a group showed lower performance in vocal emotion perception overall. Importantly, while NH individuals used timbre and fundamental frequency (F0) information to equivalent degrees, CI users were far more efficient in using timbre (compared to F0) information for this task. Thus, under the conditions of this task, CIs were inefficient in conveying emotion based on F0 alone. There was enormous variability between CI users, with low performers responding close to guessing level. Echoing previous research, we found that better vocal emotion perception was associated with better quality of life ratings.

Conclusions:

Some CI users can utilize timbre cues remarkably well when perceiving vocal emotions.

The KIDSCREEN-27 Quality of Life Measure for Romanian Children Aged 6: Reliability and Validity of the Romanian Version

The KIDSCREEN-27 represents a standardized, worldwide instrument, employed to assess the health-related quality of life in children. The purpose of the present study is to validate the KIDSCREEN-27 questionnaire for 6-year-old preparatory school children and verify its reliability, as well as to perform a comparison regarding the quality of children’s lives living in two cities in Romania: Arad, a provincial city, versus the second most developed city in the country, Cluj-Napoca. A total of 256 children of 6 years of age, who come from families with both parents, with a medium to high socioeconomic status and a good health status, were included in the analysis, using the KIDSCREEN-27 questionnaire at three assessment time points with a re-test period of two weeks. Results indicated that the KIDSCREEN-27 turned out to be suitable for use in 6-year-old Romanian children. Analysis regarding the psychometric properties showed that the Cronbach’s alpha ranged from 0.554 to 0.661 at the end of the study. The Pearson correlation coefficients showed statistically significant differences between the items of each area investigated. In conclusion, there is a growing need to periodically monitor the health status of children to avoid possible problems which may occur.

Quality of life in children with cochlear implants in Kazakhstan

BACKGROUND

Although cochlear implantation (CI) has been performed in Kazakhstan since 2007 little is known about quality of life of patients after CI. The aim of this study was to assess the health-related quality of life (HRQoL) of Kazakhstani children after CI.

METHODS

Altogether, 53 families with a child using a cochlear implant for at least 1 year participated in the study between July 20, 2019 and February 20, 2020 at the Audiological Сenter of Almaty, Kazakhstan. The parents/caregivers completed the "Children with Cochlear Implants: Parental Perspectives (CCIPP)" questionnaire.

RESULTS

'Well-being and happiness' subdomain of the HRQoL yielded the highest ratings. 'Communication', 'general functioning', 'self-reliance', and 'supporting the child' subdomains each achieved significant (p < 0.01) associations with all HRQoL subdomains. There were positive correlations between language used by the parent who completed the questionnaire (Kazakh or Russian) and three HRQoL subdomains, including 'well-being and happiness', 'supporting the child' and 'social relations'.

CONCLUSION

Parents/caregivers reported high quality of life in all HRQoL subdomains. Further research in this area with more detailed socio-demographic and medical history data is required to identify quality of life predictors in children after cochlear implantation.

Health-related quality of life after pediatric cochlear implantation

OBJECTIVES

To examine the results of health-related quality of life (HRQoL) questionnaire scores from deaf children fitted with at least one cochlear implant (CI) and compare responses to normal-hearing age-peers (NHP) and to their parents.

METHODS

This cross-sectional study included 33 pediatric patients with a hearing experience of at least 1 year with CI and a control group of 21 NHP. The KINDL^R questionnaire for measuring HRQoL (generic) in children (7-12years) and adolescents (13-17years) and a CI questionnaire (specific) were completed by CI users and their parents. Scores were transformed to a 100-point scale with 100 representing the most positive response.

RESULTS

The group of children and adolescents with CI reached a similar score in the generic HRQoL (Children:78,6; Adolescents:80,4; p = 0,35) and in the overall CI questionnaire (Children:77,6; Adolescents:75,6; p = 0,53). CI users in both age groups scored generic HRQoL similarly to their NHP (NH children:82,2, p = 0,18; NH adolescents:77,5; p = 0,07) and higher than CI users from other centers (OC) (OC children:75,4; OC adolescents:70,3). CI users scored their school domain lower than their NHP (p = 0,04). Generic and CI questionnaire scores of parents and their children correlated positively (r = 0,66, p = 0,00 and r = 0,73, p = 0,00). The total scores of HRQoL in the self-rating and parent rating correlate with none of the variables at study (gender, cause of deafness, age at implantation, years with a CI, chronological age) except with speech progression (p = 0,007).

CONCLUSIONS

Children with CI experience similar quality of life as NHP. Parents are reliable reporters on the status of their child's overall quality of life.

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model

At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.

Development and Implementation of a Low-Cost Tracking System after Newborn Hearing Screening in Upper Austria: Lessons Learned from the Perspective of an Early Intervention Provider

More than one decade after the introduction of newborn hearing screening in Upper Austria, most children were still older than 6 months at enrolment in early intervention. In this study, under the guidance of health authorities, a revised screening and tracking protocol was developed by a network of early intervention providers and representatives of ENT, obstetrics, and pediatrics, including screening professionals and parents of children with hearing loss. Critical process indicators following internationally recommended benchmarks were defined and collected annually by the health authorities. Due to data protection issues, the data collection system was not personalized. Regular network meetings, case-oriented meetings, and screener training sessions were held. As a result, even without additional costs and within the legal constraints related to data protection in Austria, the proportion of children enrolled in early intervention before 6 months of age was significantly increased from 26% to 81% in two representative birth cohorts before and after the introduction of the new protocol, respectively. The coverage for bilateral screening increased from 91.4 to 97.6% of the total number of births.

Quality of Life-CI: Development of an Early Childhood Parent-Proxy and Adolescent Version

OBJECTIVES

Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes.

DESIGN

Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use.

RESULTS

Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence).

CONCLUSIONS

The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the "whole" child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.

A review of the outcomes of children with designated additional needs receiving cochlear implantation for severe to profound hearing loss

OBJECTIVE

To evaluate one year outcomes of children with additional needs receiving cochlear implantation at the Yorkshire Auditory Implant Service (YAIS) over a ten-year period.

METHODS

Retrospective chart review yielded 270 children who received cochlear implants (CIs) at YAIS between 2007 and 2017; 49 children were classified as having additional needs. Audiological performance scales (Meaningful Auditory Information Scale (MAIS), Meaningful Use of Speech Scale (MUSS), Listening in Progress (LIP), Categories of Auditory Performance (CAP), and Speech Intelligibility Rating Scale (SIR)) were analysed pre- and 12 months post-implantation. Comparison was made with children without additional needs.

RESULTS

Children with additional needs demonstrated significantly lower pre-implantation audiological performance in MAIS, LIP, and MUSS (P <0.05). Despite showing improvement, children with additional needs consistently achieved lower scores in all metrics at one year (P < 0.05). Similarly, the rate of change was statistically significantly lower in children with additional needs.

CONCLUSION

All children were able to gain access to sound following CI. Improvements were seen in all outcome measures especially in the MAIS, CAP and LIP whereas limited improvement was seen in measures assessing speech production and improvement. The rate of improvement was statistically significantly lower in children with additional needs.

Cochlear Implants in Neurologically Impaired Children: A Survey of Health-Related Quality of Life

OBJECTIVES

Evaluate health-related quality-of-life (HRQoL) measures in noncommunicative, neurologically impaired, developmentally delayed (NCNIDD) children compared to normally developing children (ND) who undergo cochlear implantation (CI).

STUDY DESIGN

Cross-sectional survey of parents of NCNIDD and ND children who underwent CI.

SETTING

Two tertiary care medical centers.

METHODS

Questions comprising the Children With Cochlear Implants: Parental Perspectives survey were used in analysis. Average responses were calculated within 8 domains (communication, general functioning, self-reliance, well-being and happiness, social relationships, education, effects of implantation, and support the child). Groups were compared using Wilcoxon rank-sum test. Impact of individual and collective socioeconomic/family covariates was assessed using analysis of variance.

RESULTS

Surveys were returned from 17 of 42 (40%) patients with NCNIDD and 35 of 131 (27%) patients with ND. There were no statistically significant differences between groups in survey response rate, age, sex, age at implantation, current age, or duration of implant use. Overall, parents of children with ND responded more favorably in all domains vs children with NCNIDD. Parents of children with NCNIDD answered neutrally or favorably in all domains, except "support the child" and "self-reliance" domains. Differences between groups in mean domain scores, univariably and almost universally when adjusting for socioeconomic and family variables individually and collectively, were statistically significant.

CONCLUSIONS

This study suggests that HRQoL benefits of CI are perceived in most domains by parents of children with NCNIDD, albeit less strongly than children with ND. A survey sensitive to challenges of children with NCNIDD may better capture benefits that may not be apparent in this study.

Frühe Prädiktoren der Sprachentwicklung von Kindern mit permanenter Hörstörung

Zusammenfassung. Theoretischer Hintergrund: Sprachentwicklungsverläufe bei Kindern mit Hörstörungen zeigen eine hohe und überwiegend ungeklärte Varianz. Fragestellung und Methode: Unsere Übersichtsarbeit präsentiert aktuelle Evidenz zu frühen Prädiktoren der Sprachentwicklung. Ergebnisse und Diskussion: Trotz deutlicher positiver Trends erreicht nur jedes zweite Kind ein Sprachentwicklungsniveau im Normbereich. Der Literaturüberblick ergibt signifikante kindbezogene und familiäre Prädiktoren mit eher geringer Beeinflussbarkeit. Als hoch prädiktiv für sprachliche Ergebnisse und zudem der Intervention zugänglich erweisen sich die frühe Erkennung und technische Versorgung mit Hörgeräten oder -implantaten und Aufnahme in die Frühförderung, konsistente Hörtechnikverwendung und/oder früher Zugang zur Gebärdensprache. Zudem zeigt sich die Qualität der täglichen Eltern-Kind-Interaktion als hocheffektiv für die Sprachentwicklung. Schlussfolgerung: Es bestätigt sich die Wirksamkeit aktueller Best Practice früher Erkennung, Versorgung und familienzentrierter Frühförderung.

Quality of Life and Cochlear Implant: Results in Saudi Children

Objective To assess the quality of life (QoL) in Saudi children with cochlear implants (CI) and determine sociodemographic and clinical factors that have an impact on the perceived QoL. Methods A cross-sectional study is performed by comparing the QoL of Saudi toddlers and young CI recipients with normal children, using the Paediatric Quality of Life Inventory 4.0 - Generic core scale (PedsQLTM 4.0 - GCS). A self-administered questionnaire was sent to parents of paediatric patients, who had cochlear implantation at King Abdulaziz University Hospital (KAUH), from March 2016 to March 2018. Mothers of age-matched normal children who attended the obstetrics and gynaecology clinics at King Khalid University Hospital (KKUH), in November 2019 were considered as a control group. Results When children with CI and normal children PedsQLTM 4.0 - GCS subscales (physical, emotional, social, and school) and total functioning scores were compared, no single significant difference was noted between the groups. The sociodemographic and clinical factors that have an impact on the perceived QoL were: gender, birth order, and distance from the CI center. Emotional, social, psychosocial, and total functioning were the main dimensions affected. Conclusion The QoL of Saudi children with CI is comparable to those of normal children. However, among children with CI, gender, birth order, and distance from the CI center were found to have different effects on the QoL dimensions.

Quality of life and parental care burden in cochlear implanted children: A case-control study

OBJECTIVES

Cochlear implantation is a widely accepted and effective surgical method used to treat severe hearing loss. What's more, it affects the lives of both cochlear implanted children and their parents. This study aims to compare cochlear-implanted children (CIC) and their parents with healthy counterparts and their parents in terms of the quality of life (QOL) and parental care burden (CB).

METHODS

This study was conducted between February and December 2018 in Turkey after receiving approval from the ethics committee. The Case Group included 34 children between 3 and 7 years of age, who received a CI due to bilateral prelingual sensorineural hearing loss and were using it for at least 1 year, and their parents. The Control Group consisted of 68 healthy children and their parents. The data were collected using disease and age-specific quality of life scales and burden interview. Normally distributed variables were analysed using parametric tests while non-normally distributed variables were analysed using nonparametric tests. The odds ratio (OR) and confidence interval (95%) were also calculated. Results were evaluated at significance level of p < 0.05.

RESULTS

The mean age of the children and their parents in both Case and Control Groups was 63.9 months and 33.8 years, and 61.3 months and 36.6 years, respectively. There was a positive correlation between PPQ social relationship subscale and KINDL subscale scores in CIC (p < 0.05). The Case Group obtained lower mean scores from the subscales of KINDL and WHOQOL-BREF (p < 0.001, p < 0.01). The ZBI mean scores of the parents in Case and Control Groups were 43.18 and 27.54, respectively (p = 0.000).

CONCLUSION

It was determined that the QOL of the Case Group was lower than QOL of the Control Group, while the CB of the Case Group was higher than CB of the Control Group.

Translation and validation of parental perspective questionnaire for children with cochlear implant in persian language

Objective: Parental views about the outcomes of implantation on the child's quality of life are valuable sources of information for implantation specialists. The aim at this study was to validate the "Parental Perspectives" questionnaire in Persian language.Design: The original questionnaire was translated from English to Persian language; the final Persian version of questionnaire was prepared and evaluated for validity and reliability. The internal consistency of the questionnaire and test-retest reliability were respectively evaluated by Cronbach's alpha and ICC index. Factor analysis was used to determine the construct validity.Study Sample: The participants of this study were 370 parents of CI children.Results: Sampling adequacy for executing of factor analysis was confirmed by the results of Kaiser-Meyer-Olkin (=0.84) and Bartlett test (p < .05). Three factors were extracted from exploratory factor analysis. Confirmatory factor analysis confirmed the accuracy of the three-dimensional structures. Principal component analysis revealed the structural validity of three factors. Correlation between questionnaire items was good (r = 0.76). Reliability coefficient was calculated as 0.93.Conclusions: The Persian version of the questionnaire has good validity and reliability and can be used to examine the perspectives of the parents about CI.

Self-reported hearing quality of life measures in pediatric cochlear implant recipients with bilateral input

Objective: Self-reported hearing quality of life (QoL) for pediatric cochlear implant (CI) recipients was examined, asking whether 1) children with CIs have similar QoL as those with less severe hearing loss (HL); 2) children with different bilateral CI (BCI) device configurations report different QoL; and 3) do audiological, demographic and spoken language factors affect hearing QoL?Design: One hundred four children (ages 7-11 years) using bimodal devices or BCIs participated. The Hearing Environments and Reflection of Quality of Life (HEAR-QL) questionnaire, receptive language and speech perception tests were administered. HEAR-QL scores of CI recipients were compared to scores of age-mates with normal hearing and mild to profound HL.Results: HEAR-QL scores for CI participants were similar to those of children with less severe HL and did not differ with device configuration. Emotion identification and word recognition in noise correlated significantly with HEAR-QL scores.Discussion: CI recipients reported that HL hinders social participation. Better understanding of speech in noise and emotional content was associated with fewer hearing-related difficulties on the HEAR-QL.Conclusions: Noisy situations encountered in educational settings should be addressed for children with HL. The link between perception of emotion and hearing-related QoL for CI recipients should be further examined.

Health-Related Quality of Life Instruments for Children With Cochlear Implants: Development of Child and Parent-Proxy Measures

OBJECTIVES

Severe to profound hearing loss is associated with worse health-related quality of life (HRQoL), reflecting the wide-ranging effects of deafness on spoken language, cognition, and social/behavioral development. However, there are currently no cochlear implant (CI)-specific HRQoL measures that were developed using the Food and Drug Administration Guidance on patient-reported outcomes. This study developed the first HRQoL instruments (CI-QoL) for children with CIs, ages 6 to 12, and a parent-proxy measure for this age group.

DESIGN

Two phases of instrument development were conducted. Phase 1 consisted of a literature review yielding a conceptual framework and discussion guides to elicit information from stakeholder focus groups at CI clinics in Miami and Philadelphia (n = 30; e.g., physicians, speech pathologists). During phase 2, open-ended interviews were conducted with 21 parent-child dyads (M child age = 9.1 years) recruited from these two clinics. Interviews were transcribed, followed by content analysis in NVivo to identify the most frequent and difficult themes. Items were then derived from these themes to form the initial draft instruments. A multimodal approach was used to create the child-report version (i.e., pictorial representations, audio recording of items, written text above the drawings) to maximize comprehension and ease of responding. Both measures were developed to be administered electronically on a tablet device. In phase 3, a new set of parent-child dyads (n = 20; child age M = 9.2 years) completed a cognitive testing protocol to ensure clarity, ease of use, and comprehensiveness. Cognitive testing led to revisions and finalization of the instruments.

RESULTS

The final self-report measure contained 33 items across eight domains: Noisy Environments, Academic Functioning, Child Acceptance, Oral Communication, Social Functioning, Fatigue, Emotional Functioning, and Device Management. The final parent-proxy measure included 42 items on nine scales: the same eight scales that appear on the child version, with the addition of Behavior Problems. Correlations between child and parent reports on each scale ranged from r = 0.08 to 0.48.

CONCLUSIONS

CI-specific HRQoL instruments have now been developed for school-age children with CIs, with an accompanying parent-proxy version. After a psychometric validation, these CI-specific measures will enable us to track long-term outcomes, evaluate the efficacy of interventions to improve CI use (e.g., single versus bilateral implantation, AV therapy, maternal sensitivity training), and provide a profile of the "whole child's" functioning to facilitate care.

Parents' View on Quality of Life after Cochlear Implantation in Children with Auditory Neuropathy

OBJECTIVES

The aim of this study is to evaluate the quality of life in pediatric patients with auditory neuropathy according to the perspective of their parents after cochlear implantation.

MATERIALS AND METHODS

The pediatric patients, who underwent cochlear implantation with the diagnosis of auditory neuropathy at İzmir Bozyaka Training and Research Hospital ENT Clinic between January 1997 and May 2017, were included to the study. "Parents' Perspective Questionnaire" developed by Nottingham Pediatric Cochlear Implant Programme was used in the study. The questionnaire was composed of 11 subscales and 58 questions in total.

RESULTS

The study included 26 pediatric patients (14 female, 12 male) who used cochlear implant for at least 1 year. The mean age of patients was 10.91±3.85 ( 4.3-17.3 years old) and implantation age varied between 14 months and 80 months. (median; 35.65±20.03 months). Patients who attended school had more self-confidence, and also those having implant use over 6 years had a better self confidence and social relationship.

CONCLUSION

Cochlear implantation not only improves the ability of hearing but also provides development of speech and language skills and therefore enhancing the patient's quality of life. From the perspective of parents, the use of cochlear implant in the children with auditory neuropathy improves the quality of life in many different ways. The perspective of parents can provide a multidimensional evaluation about the child's progress, therefore, ıt should be taken into consideration by the staff in implant centers.

Capability of deaf children with a cochlear implant

INTRODUCTION

The main idea underlying this paper is that impairments such as deafness are particularly relevant to the extent that they lead to deprivation of capability. Likewise, the impact of healthcare services such as cochlear implants and subsequent rehabilitation can best be inferred from the extent that they protect or restore capability of those affected.

METHODS

To explore children's post-implant capabilities, we tested two newly developed digital, adaptive child self-report and parent-report questionnaires in 19 deaf children (aged 8-12 years) and their parents during rehabilitation, as well as in 23 age peers with normal hearing.

RESULTS

Despite the impressive speech-language results that were recorded with cochlear implants, the post-implant capabilities of the deaf children we evaluated differed from those of their hearing peers, with the cochlear implant group appearing particularly disadvantaged in areas such as accessing information, communication, social participation, and participation in school.

CONCLUSION

Deaf children with cochlear implants who are performing well on linguistic and auditory tests can still experience serious limitations in desired functioning. Our findings suggest that a capability approach may reveal aspects of what is being achieved through rehabilitation that might otherwise remain unnoticed, and that could help to further improve the well-being of our patients.IMPLICATIONS FOR REHABILITATIONOverall, children with cochlear implants appeared disadvantaged in certain capability areas, like accessing information, communication, social participation, and participation in school.It may be worthwhile to also ascertain capabilities in these children, representing a domain not covered by clinical measures, tapping directly into areas that are valuable to the patient.

Restricted Speech Recognition in Noise and Quality of Life of Hearing-Impaired Children and Adolescents With Cochlear Implants - Need for Studies Addressing This Topic With Valid Pediatric Quality of Life Instruments

Cochlear implants (CI) support the development of oral language in hearing-impaired children. However, even with CI, speech recognition in noise (SRiN) is limited. This raised the question, whether these restrictions are related to the quality of life (QoL) of children and adolescents with CI and how SRiN and QoL are related to each other. As a result of a systematic literature research only three studies were found, indicating positive moderating effects between SRiN and QoL of young CI users. Thirty studies addressed the quality of life of children and adolescents with CI. Following the criteria of the World Health Organization (WHO) for pediatric health related quality of life HRQoL (1994) only a minority used validated child centered and age appropriate QoL instruments. Moreover, despite the consensus that usually children and adolescents are the most prominent informants of their own QoL (parent-reports complement the information of the children) only a minority of investigators used self-reports. Restricted SRiN may be a burden for the QoL of children and adolescents with CI. Up to now the CI community does not seem to have focused on a possible impairment of QoL in young CI users. Further studies addressing this topic are urgently needed, which is also relevant for parents, clinicians, therapists, teachers, and policy makers. Additionally investigators should use valid pediatric QoL instruments. Most of the young CI users are able to inform about their quality of life themselves.

Psychosocial Outcomes in Long-Term Cochlear Implant Users

OBJECTIVES

The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes.

DESIGN

Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning.

RESULTS

CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity-impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual-spatial working memory, and inhibition-concentration skills predicted psychosocial outcomes.

CONCLUSIONS

Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.

Personality Traits, Self-Efficacy, and Cochlear Implant Use Among Deaf Young Adults

A variety of studies have examined ways in which cognitive and social-emotional factors may be linked to and affected by hearing loss, use of cochlear implants (CIs), and sign language. A related domain that largely has been overlooked, however, is personality. This paper reports a study of personality traits and self-efficacy among deaf and hard-of-hearing (DHH; n = 223) college students, with and without CIs, as compared to hearing peers (n = 106). All participants completed (HEXACO) personality trait and self-efficacy inventories; DHH participants also completed a communication questionnaire. Hearing participants scored higher on the personality trait Conscientiousness than both DHH CI users and non-CI users, as well as higher on Openness to Experience compared to DHH CI users. Hearing participants also scored higher on self-efficacy compared to DHH non-CI users. Among DHH non-CI users, greater self-rated sign language skills were associated with higher Extraversion and Agreeableness scores. Among the DHH CI users, earlier sign language acquisition was associated with higher Openness to Experience scores, and earlier cochlear implantation was associated with greater Emotionality scores. Self-efficacy was associated with both better self-rated spoken language skills and a stronger preference for spoken language over sign language use among DHH CI users.

Parents' Perception of Health-Related Quality of Life in Children With Cochlear Implants: The Impact of Language Skills and Hearing

PURPOSE

The study compared how parents of children with cochlear implants (CIs) and parents of children with normal hearing perceive their children's health-related quality of life (HR-QOL).

METHOD

The sample consisted of 186 Norwegian-speaking children in the age span of 5;0-12;11 (years;months): 106 children with CIs (53% boys, 47% girls) and 80 children with normal hearing (44% boys, 56% girls). No children had known additional disabilities affecting language, cognitive development, or HR-QOL. Parents completed the generic questionnaire Pediatric Quality of Life Inventory (Varni, Seid, & Kurtin, 2001), whereas children completed a test battery measuring different aspects of language and hearing.

RESULTS

Parents of children with CIs reported statistically significantly poorer HR-QOL in their children, on Pediatric Quality of Life Inventory total score and the subdomains social functioning and school functioning. Roughly 50% of parents of children with CIs reported HR-QOL levels (total score) within normal limits. No significant differences between groups emerged on the physical health and emotional functioning subscales. For the children in the group with CIs, better speech perception in everyday situations was associated with higher proxy-ratings of HR-QOL. Better spoken language skills were weakly to moderately associated with higher HR-QOL.

CONCLUSIONS

The findings suggest that the social and school situation is not yet resolved satisfactorily for children with CIs. Habilitation focusing on spoken language skills and better sound environment may improve social interactions with peers and overall school functioning.

Psychosocial Development in 5-Year-Old Children With Hearing Loss Using Hearing Aids or Cochlear Implants

This article reports on the psychosocial development and factors influencing outcomes of 5-year-old children with cochlear implants (CIs) or hearing aids (HAs). It further examines differences between children with CIs and HAs with similar levels of hearing loss. Data were collected as part of the Longitudinal Outcomes of Children with Hearing Impairment study-a prospective, population-based study. Parents/caregivers of children completed the Strengths and Difficulties Questionnaire ( n = 333), the Social Skills subscale from the Child Development Inventory ( n = 317), and questionnaires on functional auditory behavior (Parents' Evaluation of Aural/oral performance of Children), and demographics. Children completed assessments of nonverbal cognitive ability (Wechsler Non-verbal Scale of Ability) and language (Preschool Language Scale - fourth edition). On average, parent-rated Strengths and Difficulties Questionnaire scores on emotional or behavioral difficulties were within 1 SD of the normative mean; however, Child Development Inventory scores on social skills were more than 1 SD below the norm. Children with severe-to-profound hearing losses using HAs had significantly more behavioral problems than children with CIs. Regression analyses showed that non-verbal cognitive ability, language, and functional auditory behavior were significantly associated with psychosocial outcomes for children with HAs, whereas outcomes for children with CIs were associated with functional auditory behavior and the presence of additional disabilities. Age at hearing intervention, severity of hearing loss, and communication mode were not associated with outcomes. The results suggest that even children who develop good language ability with the help of a HA or CI may have psychosocial problems if they exhibit difficulties with listening and communicating in everyday environments. The findings have implications for developing interventions for young children with hearing loss.

Quality of Life and Cost-Effectiveness of Cochlear Implants: A Narrative Review

OBJECTIVES

To review evidence regarding the health-related quality of life (HRQoL) and cost-effectiveness of unilateral and bilateral cochlear implantation (CI) among children and adults with severe-to-profound hearing loss.

STUDY DESIGN

Narrative review.

METHODS

Publications related to quality of life (QoL) and costs of care in CI were acquired through searches in English-language databases. Studies were included if they had identified the HRQoL attainment, cost of care, cost-utility, or cost-effectiveness associated with CI.

RESULTS

57 studies were critically reviewed. The QoL outcome metrics used in these articles were divided into 2 categories - generic and condition specific. In studies investigating children, many reported no significant difference in QoL attainment between CI recipients and normal-hearing peers. In adults, significant improvements in QoL after implantation and higher QoL than in their nonimplanted (hearing-aided) peers were frequently reported. Studies involving an older adult cohort reported significant improvement in QoL after implantation, which was often independent of audiological performance. Overall, the calculated cost-utility ratios consistently met the threshold of cost acceptance, indicating acceptable values for expenditures on CI.

CONCLUSIONS

Considerable work has been done on the QoL attainment and health economic implications of CI. Unilateral CI across all age groups leads to reported sustained benefits in the recipients' overall and disease-specific QoL. With increased cost associated with bilateral CI, further study is needed to characterize its costs and benefits with respect to the recipients' health, well-being, and contributions to society.

Perceived Quality of Life Among Adults With Hearing Loss: Relationships With Amplification Device and Financial Well-Being

The current study explored the relationship between perceived quality of life and financial well-being among adult cochlear implant (CI) users as compared with hearing aid (HA) users. Participants were 66 adults: 30 CI users and 36 HA users. They completed the Perceived Quality of Life for Deaf and Hard-of-Hearing (DHH) scale, the In Charge Financial Distress/Financial Well-Being scale, and a background questionnaire. Significant differences were found between the two study groups in two perceived quality-of-life factors: participation, t(58) = 1.71, p < .05, and perceived stigma, t(58) = −1.80, p < .05. CI users reported higher levels of participation and lower levels of perceived stigma as compared with HA users. In addition, financial well-being was a significant predictor of participation (β = .32, p < .05), and CI users who used their device for a longer time reported higher levels of financial well-being ( r = .35, p < .05). Research findings emphasize the possible contribution that both CIs and financial well-being may have on the perceived quality of life of DHH adults. In addition, time since implantation may be an important variable when measuring improvements after cochlear implantation, especially when evaluating long-term processes, such as changes in financial well-being.

Unilateral hearing loss in children: a retrospective study and a review of the current literature

Despite the introduction of universal newborn hearing screening (UNHS), unilateral hearing loss (UHL) is sometimes recognized late. This diagnostic delay has adverse repercussions, given the importance of binaural hearing for the development of normal auditory processing. It is incorrect to maintain that unilateral hearing is the minimum requirement for adequate speech development and that hearing aid provision is consequently unnecessary. In our retrospective study, hearing aid provision resulted in improved directional and selective hearing (quiet and noisy environments) and, compared with their chronically ill counterparts, the children in our study displayed superior health-related quality of life (HRQoL) scores in all areas. On the basis of the results, the authors conclude that even mild hearing losses (from an auditory threshold of 30 to 40 dB) should have the opportunity for hearing aid provision. A selective literature review was conducted in PubMed and textbooks and with reference to national and international guidelines. Early diagnosis and treatment of UHL have a positive effect on verbal-cognitive, linguistic, communicative, and socio-emotional development, as demonstrated by neurophysiological studies. Among the treatment modalities with differing effects on the quality of binaural hearing, cochlear implants are now used increasingly in children with hearing loss bordering on deafness.

CONCLUSION

Published evidence and clinical experience support early diagnosis and treatment. Wherever feasible, hearing aid provision before or at the end of the first year of life is recommended for children with UHL. What is Known: • Almost 30 years ago, poor academic performance was reported in children with unilateral hearing loss (UHL). • Despite improvements in treatment options, it is traditionally held that unilateral hearing is the minimum requirement for adequate speech development and hearing aid provision is unnecessary. What is New: • Academic and behavioral deficits in children with UHL may be mediated by deficiencies in the default mode network. • Published evidence supports the recommendation for hearing aid provision before or at the end of the first year of life in children with UHL.

Exploring the experiences of teenagers with cochlear implants

OBJECTIVES

Teenage cochlear implant users' perceptions of deafness, surgery, fitting of the device and life as a cochlear implant wearer were explored in order to gain a more comprehensive understanding of teenagers' experiences of living with the device.

METHODS

Semi-structured in-depth interviews were undertaken and analysed using thematic analysis. Ten teenagers aged 14-16 years with at least one cochlear implant were interviewed.

RESULTS

Seven teenagers experienced great pre-operative anxiety and two reported significant post-operative pain. Four of the teenagers described a mismatch between their expectations and the disappointing reality of adjusting to the device. However, all the teenagers reported an enhanced sense of well-being as a result of being able to interact more easily with their world around them. The teenagers differed in the extent to which they identified with the hearing and deaf world.

DISCUSSION

Despite the early challenges, over time the teenagers experienced many functional and psychosocial benefits. Most felt their lives were now easier as a result of the cochlear implant(s). They described complex, flexible identities.

CONCLUSIONS

By giving prominence to the teenagers' voices this study has added new knowledge concerning their experience of surgery. The findings also more fully revealed the challenges of adjusting to the device and the impact of having a cochlear implant on the teenagers' identities. Clinical recommendations are made to address the gaps in service highlighted by these findings.

Brief Assessment of Parental Perception (BAPP): Development and validation of a new measure for assessing paediatric outcomes after bilateral cochlear implantation

OBJECTIVE

In contrast to previous clinical practice, current guidelines recommend bilateral cochlear implantation in children, resulting in a cohort of children who initially received one implant, but have subsequently had a second, contralateral implant. This study aimed to explore satisfaction and quality of life in children implanted simultaneously or sequentially.

DESIGN

A novel measure of satisfaction and quality of life following paediatric bilateral cochlear implantation (the Brief Assessment of Parental Perception; BAPP) was developed and preliminary validation undertaken as part of a large, national project of bilateral implantation. Children's parents completed the measure yearly for up to three years following implantation.

STUDY SAMPLE

Children from 14 UK implant centres were recruited into the study; data were available for 410 children one year post-implantation.

RESULTS

The BAPP was found to have good face and convergent validity, and internal consistency. Results indicated very high levels of satisfaction with the devices, and improvements in quality of life. However there was evidence that children implanted sequentially were less willing to wear their second implant in the first two years than those children receiving simultaneous implants.

CONCLUSION

Simultaneous and sequential cochlear implants have a positive impact on the quality of life of deaf children.

LifeQuestionnaire. A new tool for the evaluation of quality of life in patients with hearing loss-using WhatsApp

OBJECTIVE

Develop an online application that sends questions at different times of the day over an interval set by the user. It consists of a web interface that sends out WhatsApp messages containing questions from already validated or customized questionnaires (previous license) and shows the evolution of each question and patient over time and their average.

MATERIAL AND METHOD

The Laboratory of Psychoacoustics developed a platform that allows patients to answer surveys from remote locations.

RESULTS

Hence, the developed tool allows to: (1) answer a test repeatedly under different personal situations and (2) evaluate the patient remotely. Hence, obtaining a more reliable assessment of the patient's QoL.

CONCLUSION

Preliminary results using 5 teenagers aged 12-18 that answered the KINDL questionnaire is used to evidence the value of this new tool.

Quality of Life in Children with Hearing Impairment: Systematic Review and Meta-analysis

OBJECTIVE

To determine the impact of pediatric hearing loss (HL) on quality of life (QOL).

DATA SOURCES

A qualified medical librarian conducted a literature search for relevant publications that evaluate QOL in school-aged children with HL.

REVIEW METHODS

Studies were assessed independently by 2 reviewers for inclusion in the systematic review and meta-analysis.

RESULTS

From 979 abstracts, 69 were identified as relevant; ultimately, 40 articles were included in the systematic review. This review revealed that children with HL generally report a lower QOL than their normal-hearing peers and that QOL improves after interventions. The extent of these differences is variable among studies and depends on the QOL measure. Four studies using the Pediatric Quality of Life Inventory (PedsQL) had sufficient data for inclusion in a meta-analysis. After studies were pooled, statistically and clinically significant differences in PedsQL scores were found between children with normal hearing and those with HL, specifically in the social and school domains. Statistically significant differences were also noted in total scores for children with unilateral HL and in the physical domain for children with bilateral HL as compared with those having normal hearing; however, these differences were not clinically meaningful.

CONCLUSIONS

Our analysis reveals that decreased QOL in children with HL is detected in distinct domains of the PedsQL. These domains-school activities and social interactions-are especially important for development and learning. Future work should focus on these aspects of QOL when assessing HL in the pediatric population.

Deaf adolescents in a hearing world: a review of factors affecting psychosocial adaptation

Adolescence has long been viewed as a time of rapid change in many domains including physical, cognitive, and social. Adolescents must adapt based on developing skills and needs and acclimate to growing environmental pressures. Deaf adolescents are often faced with the additional challenge of managing these adaptations in a hearing world, where communication and access to information, especially about their social world, are incomplete at best and nonexistent at worst. This article discusses the research on several factors that influence a deaf adolescent's adaptation, including quality of life, self-concept, and identity development. Gaps in our knowledge are pointed out with suggestions for future research programs that can facilitate optimal development in adolescents who are deaf.

Long-term functional and behavioral-emotional outcomes in children with early cochlear implants: Parental testimonies

OBJECTIVES

(1) To assess the long-term effects of cochlear implantation (CI) on speech perception and school life, and (2) to evaluate behavioral and emotional development, including social skills, post-implantation.

METHODS

We telephoned caregivers and asked them a standardized questionnaire. We used the data to explore the daily lives (including school life) of children who had undergone CI before the age of 4 years and who had used the device for >10 years. We also evaluated behavioral/emotional development.

RESULTS

Most children used CI devices for virtually all their waking moments and attended mainstream schools. Moreover, more than 75% of them could comprehend common phrases or conversations without lip-reading and carry out a telephone conversation with a person known to them. The mean T-scores for all scales of behavioral/emotional assessment, including those concerning social skills, were within the normal ranges, although scores on the competence scale were lower than those on other scales.

CONCLUSIONS

This long-term study of early-CI children shows that CI improves not only speech perception, but also behavioral/emotional development, including social skills.

Parents' Stress and Coping Related to Children's Use of a Cochlear Implant: A Qualitative Study

The aim was to increase understanding of parents' experiences of having a child with a cochlear implant (CI) and to explore how these related to children's use of CI. Twelve parents of children, full-time users or limited users of CIs, participated in the study. Qualitative content analysis showed that the parents of children who used their CI differed from the parents with limited users in how they handled stressors. Support from health care professionals was seen as insufficient. Parents need to get involved in dynamic processes in which health care resources promote parental coping.

Self-reports versus parental perceptions of health-related quality of life among deaf children and adolescents

The aim of this study was to assess the agreement between deaf children's and adolescents' self-ratings of health-related quality of life (HRQoL) and their parents' proxy reports. This observational cross-sectional study included 114 deaf 8- to 18-years-old students and proxy family members. HRQoL was measured using the KIDSCREEN-27 questionnaire, which was adapted to Spanish sign language for children, with a written version for parents. Respondents completed a self-administered paper questionnaire. Parents' and children's mean scores differences were not significant, except for the "Autonomy and Parents" and "Peers and Social Support" dimensions. Children aged 8-11 years scored higher in some domains of QoL compared to those aged 12-18 years. The level of agreement between children/adolescents' and parents/proxies' responses was acceptable, except for the dimension "Autonomy and Parents." Overall, deaf children/adolescents' self-ratings of HRQoL did not differ from their parents' proxy reports; however, differences were found in the dimensions that explored the quality of the interaction of children/adolescents and parents, the perceived level of autonomy, and social relations and support.

Self-esteem in children and adolescents with hearing loss

Children with hearing loss are at risk for lower self-esteem due to differences from hearing peers relative to communication skills, physical appearance, and social maturity. This study examines the influence of generic factors unrelated to hearing loss (e.g., age, gender, temperament) and specific factors associated with hearing loss (e.g., age at identification, communication skills) on how children with hearing loss wearing cochlear implants or hearing aids appraise self-esteem. Fifty children with hearing loss wearing cochlear implants or hearing aids participated (Mean age: 12.88 years; mean duration of device use: 3.43 years). Participants independently completed online questionnaires to assess communication skills, social engagement, self-esteem, and temperament. Children with hearing loss rated global self-esteem significantly more positively than hearing peers, t = 2.38, p = .02. Self-esteem ratings attained significant positive correlations with affiliation (r = .42, p = .002) and attention (r = .45, p = .001) temperaments and a significant negative association with depressive mood (r = − .60, p < .0001). No significant correlations emerged between self-esteem and demographic factors, communication skills, or social engagement. Because successful communication abilities do not always co-occur with excellent quality of life, clinicians and professionals working with children with hearing loss need to understand components contributing to self-esteem to improve identification, counseling, and external referrals for children in this population.

Quality of life evaluation in children with cochlear implants

PURPOSE: To evaluate the quality of life of children with cochlear implants from the perspective of their parents. METHODS: A clinical and cross-sectional study was conducted with 15 parents of children using cochlear implants of both genders aged between 2 and 12 years old. Parents of these children answered the questionnaire "Children with Cochlear Implants: Parental Perspective" (CCIPP). Data related to auditory category and time of cochlear implants use were collected from medical records of the children. The percentages of responses on the CCIPP domains were tabulated and descriptively and inferentially analyzed. RESULTS: The cochlear implants had a positive effect on the quality of life of children in the self-reliance (58.9%) and social relationships (56.7%) domains. No correlation was observed between the time of cochlear implants activation (months) and any of the CCIPP domains. However, children with 24 months or less of cochlear implant use presented higher percentages on the communication domain than those with more than 24 months of cochlear implants use. A negative correlation was observed between the auditory category and the effects of the implant domain. CONCLUSION: From the perspective of parents, the use of cochlear implants improves the quality of life of their children; the shorter the time of cochlear implants use, the higher the improvement in quality of life; and the more developed the auditory skills, the lower the percentage of quality of life improvement with the cochlear implants.