Education and training of young people who grew up with cochlear implants

Long-Term Educational and Occupational Status of Prelingually Deaf Children Who Have Received a Cochlear Implant

OBJECTIVE

To investigate the long-term educational and occupational status of prelingually bilateral deaf children who received a cochlear implant (CI) before the age of 7, and to identify factors that influence these outcomes.

STUDY DESIGN

Retrospective chart review.

SETTING

Single tertiary care center.

METHODS

Seventy-one children who underwent CI surgery from 2000 to 2007 were included. The latest education and occupation status and word recognition score (WRS) were analyzed.

RESULTS

The mean age at the time of surgery and the current age was 3.9 and 22.4 years. The age at CI showed a negative correlation with WRS. All subjects had graduated from high school or obtained an equivalent educational qualification. General high school graduates showed a higher WRS than those who attended a special education high school. The college entrance rate of CI patients (74.6% %) was comparable to that of the general population (72.5%). Subjects who went to college had a significantly better WRS than those who did not (51.4% vs 19.3%). Excluding 30 subjects currently enrolled in college, 26 (62%) of the remaining 41 were currently employed and engaged in various vocational activities, of which most (21 out of 26, 81%) were employed through vocational training institutes, or via special recruitment policy for the disabled.

CONCLUSION

The long-term use of CI in prelingually deaf children enables not only speech perception but also produces comparable levels of education and employment to those of the general population. A good WRS and supportive policy were related to these successful outcomes.

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.

Perspectives of D/HH-Students on Mainstream Higher Education: A Qualitative Study

Social, contextual, and technological changes affected the educational context for students who are deaf or hard of hearing (D/HH) in higher education in many countries. Although, several barriers to academic success already have been identified, the perspectives of D/HH-students on inclusion, educational facilities, and support are important to overcome them. This interview-based qualitative study describes the perspectives of 32 D/HH-students in mainstream higher education in The Netherlands. Within the dichotomy of environmental factors and personal factors, data have been analysed. Students experienced social acceptance by others with typical hearing, although participating in social events sometimes caused feelings of loneliness or separation. Access arrangements and adjustments in educational programs were necessary to cope with the experienced fatigue, participate during lectures or increase speech intelligibility of the lecturer. Especially poor classroom acoustics and limited intelligibility of speech hampered students during lectures. Students expressed their dissatisfaction about the way access arrangements and adjustments were arranged, yet at the same time, they do not know what the requested help should look like. A co-created policy in which D/HH-students, student support officers, and institutional policy makers are involved, would support D/HH-students in mainstream higher education in The Netherlands and abroad in their needs.

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

(1) Objectives: For full benefit in children implanted with a cochlear implant (CI), wearing the device all waking hours is necessary. This study focuses on the relationship between daily use and audiological outcomes, with the hypothesis that frequent daily device use coincides with high device satisfaction resulting in better functional gain (FG). Confounding factors such as implantation age, device experience and type of device were considered. (2) Results: Thirty-eight CI children (65 ears) were investigated. In total, 76.92% of the children were using their device for >12 h per day (h/d), 18.46% for 9−12 h/d, the remaining for 6−9 h/d and one subject reported 3 h/d. The revision rate up to the 90-month follow-up (F/U) was 4.6%. The mean FG was 59.00 ± 7.67 dB. The Audio Processor Satisfaction Questionnaire (APSQ) separated for single unit (SU) versus behind the ear (BTE) devices showed significantly better results for the latter in terms of wearing comfort (WC) (p = 0.00062). A correlation between device use and FG was found with a device experience of <2 years (n = 29; r2 = 0.398), whereas no correlation was seen with ≥2 years of device experience (n = 36; r2 = 0.0038). (3) Conclusion: This study found significant relationships between daily device use and FG, wearing comfort and long-term safety (90 months).

Wellbeing as Capability: Findings in Hearing-Impaired Adolescents and Young Adults With a Hearing Aid or Cochlear Implant

In the Western world, for deaf and hard-of-hearing children, hearing aids or cochlear implants are available to provide access to sound, with the overall goal of increasing their wellbeing. If and how this goal is achieved becomes increasingly multifarious when these children reach adolescence and young adulthood and start to participate in society in other ways. An approach to wellbeing that includes personal differences and the relative advantages and disadvantages that people have, is the capability approach, as developed by Nobel Prize laureate Amartya Sen. Capability is the set of real opportunities people have to do and be things they have reason to value. We interviewed 59 young people, aged 13 through 25, with cochlear implants (37) or hearing aids (22) to capture their capability. We found that their hearing devices enabled them to actively participate in a predominantly hearing society, with few differences between cochlear implant and hearing aid recipients. They did, however, report challenges associated with prejudices and expectations, and with feeling poorly understood, all of which appeared to impact their capability. Through the lens of capability, alleged differences between hearing aid and cochlear implant recipients began to fade. We discuss the implications for initiatives focused on the long-term support young recipients of hearing devices to meet their specific requirements over time.

Evaluating the Revised Work Rehabilitation Questionnaire in Cochlear Implant Users Cochlear Implant Outcome Assessment Based on the International Classification of Functioning, Disability, and Health (ICF)

OBJECTIVES

The 59-item Work Rehabilitation Questionnaire (WORQ) was developed based on the International Classification of Functioning, Disability and Health (ICF) core set for vocational rehabilitation to assess work related functioning. It was revised to include 17 questions, assigned to 14 ICF categories relevant to cochlear implant (CI) users. This cross-sectional multicenter study aimed to evaluate CI users' responses on the WORQ questions to describe and generate ICF qualifiers for the revised WORQ in CI users, forming part of a broader framework of CI outcome measures linked to the ICF.

METHODS

One hundred seventy-seven adults over the age of 18 years with a minimum of one year's device experience were included in the analysis. The WORQ was completed by the participants at a routine visit to the clinic, via email, or via post.

RESULTS

Most of the CI users perceived no problem on the WORQ questions (53.7%-91%), finished secondary school (54.2%) or obtained a college or university degree (32.8%) and are either employed (41.2%) or retired (34.5%). CI users that are currently working mostly have a full-time position (34.5%). Subjects reported no problem (91%) with sensation of falling, while handling communication devices and techniques (10.9%) and tinnitus (9.6%) showed the highest number of subjects reporting a complete problem.

CONCLUSIONS

Overall, most of the CI users experienced no impairment, restriction or limitation on the WORQ questions and their assigned ICF categories. Their education level resembles the education level of the general population and they seem to integrate or reintegrate well in professional life postoperatively.

Effect of Age at Cochlear Implantation in Educational Placement and Peer Relationships

OBJECTIVES

The education and school life of children who have undergone cochlear implantation (CI) is very important and should be monitored continuously. This study assessed auditory performance in children with cochlear implants over time, along with educational placement and peer relationship, and compared the results based on the age at CI and the presence of additional disabilities.

DESIGN

In total, 77 children who had undergone CI at the Hearing Center in Ajou University Hospital at less than 10 years old and who were presently attending school or had already graduated from school within 3 years were enrolled in this study. All children had congenital bilateral severe or profound hearing loss at the diagnosis. They were classified based on the age at which they received CI: the "early-implanted group," younger than 3.5 years (n = 38), and the "late-implanted group," between 3.5 and 10 years old (n = 39).

RESULTS

The early-implanted group had worse short-term auditory performance than the late group, but after 2 years of the implant use, auditory performance was similar in both groups. The early and late groups did not differ significantly in terms of the proportions of children who were enrolled in a regular school (94.7% and 89.7%, respectively). However, the early-implanted group had a larger proportion of children who were enrolled in a regular school without additional needs (73.0%), compared with the late group (48.6%) (p = .034). Children with multiple disabilities showed poorer performance (word score of 57.7% and sentence score of 44.7%) than children with hearing disability only (91.8% and 87.2%, respectively), which affected full-time enrollment in regular schools. With regard to peer relationships, 19.0% of children in the early-implanted group required close observation and assistance, and 9.5% even required help and counseling. Children who underwent early CI had a high tendency toward social restraint, apathy, and over-commitment. No correlations were observed between audiological factors and the aspects of peer relationships assessed in this study.

CONCLUSIONS

Early CI and the absence of other disabilities were the two main factors that increased the likelihood of full-time enrollment in mainstream classes at regular schools. Nevertheless, many children who underwent earlier CI still encountered difficulties in peer relationships.

Listening Difficulties of Children With Cochlear Implants in Mainstream Secondary Education

OBJECTIVES

Previous research has shown that children with cochlear implants (CIs) encounter more communication difficulties than their normal-hearing (NH) peers in kindergarten and elementary schools. Yet, little is known about the potential listening difficulties that children with CIs may experience during secondary education. The aim of this study was to investigate the listening difficulties of children with a CI in mainstream secondary education and to compare these results to the difficulties of their NH peers and the difficulties observed by their teachers.

DESIGN

The Dutch version of the Listening Inventory for Education Revised (LIFE-R) was administered to 19 children (mean age = 13 years 9 months; SD = 9 months) who received a CI early in life, to their NH classmates (n = 239), and to their teachers (n = 18). All participants were enrolled in mainstream secondary education in Flanders (first to fourth grades). The Listening Inventory for Secondary Education consists of 15 typical listening situations as experienced by students (LIFEstudent) during class activities (LIFEclass) and during social activities at school (LIFEsocial). The teachers completed a separate version of the Listening Inventory for Secondary Education (LIFEteacher) and Screening Instrument for Targeting Educational Risk.

RESULTS

Participants with CIs reported significantly more listening difficulties than their NH peers. A regression model estimated that 75% of the participants with CIs were at risk of experiencing listening difficulties. The chances of experiencing listening difficulties were significantly higher in participants with CIs for 7 out of 15 listening situations. The 3 listening situations that had the highest chance of resulting in listening difficulties were (1) listening during group work, (2) listening to multimedia, and (3) listening in large-sized classrooms. Results of the teacher's questionnaires (LIFEteacher and Screening Instrument for Targeting Educational Risk) did not show a similar significant difference in listening difficulties between participants with a CI and their NH peers. According to teachers, NH participants even obtained significantly lower scores for staying on task and for participation in class than participants with a CI.

CONCLUSIONS

Although children with a CI seemingly fit in well in mainstream schools, they still experience significantly more listening difficulties than their NH peers. Low signal to noise ratios (SNRs), distortions of the speech signal (multimedia, reverberation), distance, lack of visual support, and directivity effects of the microphones were identified as difficulties for children with a CI in the classroom. As teachers may not always notice these listening difficulties, a list of practical recommendations was provided in this study, to raise awareness among teachers and to minimize the difficulties.

Multicenter Study Investigating Foreign Language Acquisition at School in Children, Adolescents, and Young Adults With Uni- or Bilateral Cochlear Implants in the Swiss German Population

OBJECTIVES

Evaluation of foreign language acquisition at school in cochlear implant patients.

STUDY DESIGN

Multicenter cohort study.

SETTING

CI centers.

PATIENTS

One hundred twenty-five CI users (10-18 yr) in the German-speaking part of Switzerland were enrolled. Demographic data were obtained by means of written questionnaires. German-speaking children with mainstream foreign language tuition (English and/or French) were enrolled for further testing. The control group of normal-hearing individuals was matched on age, class, and number of foreign language lessons attended.

RESULTS

Overall, 100 questionnaires were returned. The 12 CI users without foreign language learning attended special schools. CI users who attended foreign language classes had better German speech comprehension compared with those without foreign language tuition (89 versus 51%; p < 0.05). Thirty-one CI users of different grades were further tested. All (10/10) CI 6th graders attained the school objectives for both English reading and listening skills. French performance at 6th grade for reading was 3/7 and for listening only 1/7. There were 13 matched normal-hearing pairs for English and 10 for French. The total scores were on average 7% higher, with a statistical significance for English reading (p < 0.05).

CONCLUSIONS

Almost 90% of CI children in Switzerland learn foreign language(s) at school. All the tested patients reached the current school objectives for English reading. The success rate for French was lower, especially regarding listening tasks. The 13 matched pairs with normal-hearing did not score substantially better.

Work and Employment Characteristics of Deaf and Hard-of-Hearing Adults

Studies have reported a higher level of unemployment among deaf and hard-of-hearing (DHH) adults compared to adults without hearing loss. However, little is known about factors explaining success in the labor market. This study presents the analysis of two data sets. The first was drawn from a survey of 804 DHH adults in Denmark. The second was a survey completed by 190 DHH adults with post-secondary qualification in the United States. In the Danish sample, among the spoken language users, higher ages, higher level of educational attainment, and no additional disabilities were associated with having a job. Among the sign language users, higher ages, higher level of educational attainment, earlier ages at hearing loss diagnosis, and not using cochlear implants were associated with having a job. In the US sample, male gender and better sign language skills were associated with having a job.

Educational Status in Bilateral Prelingual Deaf Children with Cochlear Implantation

Background and Objectives

This study was undertaken to investigate the educational status in bilateral prelingual deaf children with a cochlear implant (CI), also known as early cochlear implantees (CIs). Type of schooling and enrollment rate of tertiary education were analyzed as primary results.

Subjects and Methods

Participants in this study comprised a highly homogeneous group of deaf patients who underwent cochlear implantation at a similar age. Sixty-four Korean patients were enrolled. Statistical data for disabled populations and the general population were obtained from the National Statistics Korea.

Results

Among 64 patients, 46, 8, and 10 attended mainstream, integrated, and special schools, respectively. Notably, there was a significant difference in the type of school between hearing-impaired and CI groups (p=0.007). Ten of 13 patients enrolled in tertiary education.

Conclusions

CI users were more likely than hearing impaired students to attend mainstream school. The enrollment rate of CI users in tertiary education was the same as that of the general population.

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.

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.

Auditory Environment Across the Life Span of Cochlear Implant Users: Insights From Data Logging

PURPOSE

We describe the natural auditory environment of people with cochlear implants (CIs), how it changes across the life span, and how it varies between individuals.

METHOD

We performed a retrospective cross-sectional analysis of Cochlear Nucleus 6 CI sound-processor data logs. The logs were obtained from 1,501 people with CIs (ages 0-96 years). They covered over 2.4 million hr of implant use and indicated how much time the CI users had spent in various acoustical environments. We investigated exposure to spoken language, noise, music, and quiet, and analyzed variation between age groups, users, and countries.

RESULTS

CI users spent a substantial part of their daily life in noisy environments. As a consequence, most speech was presented in background noise. We found significant differences between age groups for all auditory scenes. Yet even within the same age group and country, variability between individuals was substantial.

CONCLUSIONS

Regardless of their age, people with CIs face challenging acoustical environments in their daily life. Our results underline the importance of supporting them with assistive listening technology. Moreover, we found large differences between individuals' auditory diets that might contribute to differences in rehabilitation outcomes. Their causes and effects should be investigated further.

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.

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.

School failure in students who are normal-hearing or deaf: with or without cochlear implants

To evaluate the impact of cochlear implants on the school failure of deaf who attend mainstream classes by comparing them to their normal-hearing peers as well as deaf without cochlear implants. This case–control study included participants aged 8–18 years. The number of school years failed was obtained from school records. The greatest differences in achievement levels were found between hearing students and those who were deaf without cochlear implants. Cochlear implants provide educational opportunities for hearing-impaired students, yet those without cochlear implants remain at a great disadvantage. These findings suggest that measures promoting greater equity and quality for all deaf students allow achievement levels closer to those of the not impaired.

Schooling Relates to Mental Health Problems in Adolescents with Cochlear Implants-Mediation by Hearing and Family Variables

Aim of this multicenter study was to investigate whether schooling relates to mental health problems of adolescents with cochlear implants (CI) and how this relationship is mediated by hearing and family variables. One hundred and forty secondary school students with CI (mean age = 14.7 years, SD = 1.5), their hearing parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ). Additional audiological tests (speech comprehension tests in quiet and noise) were performed. Students of special schools for hearing impaired persons (SSHIs) showed significantly more conduct problems (p < 0.05) and a significantly higher total difficulty score (TDS) (p < 0.05) compared to students of mainstream schools. Mental health problems did not differ between SSHI students with sign language education and SSHI students with oral education. Late implanted students and those with indication for additional handicaps were equally distributed among mainstream schools and SSHIs. However, students in SSHIs were more restricted to understand speech in noise, had a lower social background and were more likely to come from single-parent families. These factors were found to be partial mediators of the differences in mental health problems between the two school types. However, no variable could explain comprehensively, why students of SSHIs have more mental health problems than mainstream pupils.

Practitioners' perspectives on the functioning of school-age children with cochlear implants

OBJECTIVE

The availability of cochlear implants has increased the number of children with profound deafness educated in classrooms alongside peers with normal hearing. The purpose of this research was to better understand the functioning of these children from the perspective of their service providers.

METHODS

Semi-structured focus group interviews were conducted with 28 practitioners to elicit their perceptions of children's abilities in oral communication, academic, and social functioning. Data were coded inductively and examined through content analysis.

RESULTS

The central theme was that cochlear implantation has improved school functioning for children both in hearing and related spoken language abilities and beyond hearing in academic and social development. While these benefits were a consistent theme, a wide range of performance was identified across all areas of functioning. In particular, areas of concern included full participation in classroom activities and social interaction with peers.

CONCLUSIONS

The findings provide insights into functioning for children with cochlear implants from the perspective of those who interact with them in everyday settings. These findings underscore the challenges for children in achieving full participation despite improvements in communication skills. Practitioners identified areas where intervention is required to facilitate the inclusion of children in school programs.

Effectiveness of cochlear implants in children: long term results

OBJECTIVES

This study aimed to evaluate the effectiveness, according to the hearing threshold and language performance, of cochlear implants through a period of 10 or more years of follow-up.

METHODS

A retrospective chart review was conducted. 132 patients were selected from the children's population that underwent cochlear implantation at the Department of Otorhinolaryngology, Centro Hospitalar e Universitário de Coimbra, from 1992 to 2001, with a minimum follow-up period of 10 years. A comparison of the pure-tone and speech audiometric thresholds between two periods (T0 and T1) was performed. T0 refers to the initial evaluation, immediately after the rehabilitation programme, within the first year after cochlear implantation. T1 refers to the most recent annual assessment, carried out in 2010 and 2011. Speech understanding was also evaluated through word and sentence recognition tests.

RESULTS

No statistically significant differences were found between early and late assessments, in paediatric cochlear implants users, after a 10 years period of cochlear implantation. Both speech and pure-tone audiometry seem to stabilize except for 2000 Hz where the results were even better after 10 years. Factors such as age at time of implantation, duration of deafness, aetiology and exchange of the speech processor do not seem to have a role in auditory performance after a long rehabilitation period. In tests of verbal discrimination rates of words and phrases recognition were of 84.6% and 65.1%, respectively.

CONCLUSIONS

Cochlear implant is an effective treatment for severe to profound hearing loss in children, contributing to a hearing performance and an appropriate language acquisition, currently comparable to normal hearing children. These benefits appear to keep stable over the years. No deterioration was identified.

Growing up with a cochlear implant: education, vocation, and affiliation

The long-term educational/vocational, affiliation, and quality-of-life outcomes of the first and second cohorts of children with bilateral, profound hearing loss who received cochlear implants under a large National Institutes of Health-funded study was investigated in 41 of 61 eligible participants. Educational and vocational outcomes were collected from user survey data. Affiliation and quality-of-life data were collected from the Satisfaction-with-Life scale and the Deaf Identity Scale. Qualitative results indicated that compared with their hearing, adult-age peers, this group obtained high educational achievement, and they reported a very high satisfaction of life. With respect to forming an identity in these first 2 cohorts of cochlear implant users, we found that most of the individuals endorsed a dual identity, which indicates they feel just as comfortable with Deaf individuals as they do with hearing individuals. Quantitative results revealed a significant relationship between ability to hear and ability to speak, in addition to consistency of device use. Additional relationships were found between mother's and the individual's educational statuses, hearing scores, and communication system used. Younger individuals scored higher on satisfaction-with-life measures, and they also tended to endorse a dual identity more often. Taken together, these findings diminish concerns that profoundly deaf individuals growing up with cochlear implants will become culturally bereft and unable to function in the hearing world.

Suprameatal approach for cochlear implantation in children: our experience with 320 cases

OBJECTIVE

To summarize our experience with the 320 children who underwent cochlear implantation by the suprameatal approach (SMA).

METHOD

The SMA involves entering the middle ear by retroauricular tympanotomy. After drilling of the cochleostomy and of the suprameatal tunnel, the electrode is passed through the suprameatal tunnel underneath to the chorda tympani and lateral to the incus into the cochleostomy.

RESULTS

The following implant-related complications required explantation with subsequent reimplantation: foreign body reaction (0.6%), allergy to implant (0.3%), and protrusion of the positioner (0.3%). Post-traumatically displaced magnets were reinserted in 3 (0.9%) children. All the vestibular (5.3%) and wound (3.1%) problems were considered as being patient-related and resolved spontaneously or were managed conservatively. There were no surgery-related complications and no cases of mastoiditis developed among the children implanted with the SMA.

CONCLUSIONS

The SMA enables a decreasing the rate of surgery-related complications and safe electrode insertion.