The Sound Access Parent Outcomes Instrument (SAPOI): Construction of a new instrument for children with severe multiple disabilities who use cochlear implants or hearing aids

Cochlear Implant Decision Making for Children With Residual Hearing: Perspectives of Practitioners

PURPOSE

Cochlear implants (CIs) are increasingly considered for children with residual hearing who benefit from hearing aids (HAs). However, the decision-making process for families of these children and for practitioners is particularly challenging because there is no clear audiological cut point for CI candidacy. This study aimed to understand Canadian practitioners' perspectives of the CI decision-making process and how they guide families of children with residual hearing.

METHOD

Semistructured interviews were conducted with a total of 17 practitioners through four focus groups and one individual interview. Interviews were transcribed verbatim, and a thematic analysis was carried out.

RESULTS

Data were organized into five broad domains: candidacy issues for children with residual hearing, practitioners' roles in decision support, additional considerations affecting decision making, factors facilitating decision making, and practitioners' needs.

CONCLUSIONS

This study found that practitioners' confidence in determining candidacy and supporting parents has increased due to their experiences with positive outcomes for these children. Practitioners indicated that there was a need for more research to guide the decision-making process.

Children with cochlear implant and additional disabilities benefit from consistent device use

OBJECTIVES

Although the prevalence of additional disabilities (AD) in children with a cochlear implant (CI) is high, children with such disabilities are often excluded from clinical studies, or their specific characteristics are only partially included. The literature shows that several factors need to be considered in evaluating auditory and language development in CI children with AD, including demographic variables as well as the severity and type of disability. Current findings on device use in children show correlations with auditory and language outcome, but little is known about device use specifically in children with AD. The purpose of this study was to determine the auditory and language outcome of CI children with AD and to analyse their datalogging-based daily device use, both 1 year and 2 years after implantation. In addition, any potential correlations between outcome and device use were to be identified.

METHODS

A cohort of 32 CI children with 5 different types of AD were included in this retrospective analysis. The children's auditory and language outcome was assessed by the parental questionnaires LittlEARS and ELFRA and by the professional observation tool CAP (Categories of Auditory Performance) 1 and 2 years after implantation. Longitudinal device use was analysed by using the CI system-integrated data-logging; daily duration of CI use, number of coil disconnections and exposure to different listening scenes were recorded.

RESULTS

Overall, the cohort's auditory and language performance showed significant progress over time, while reduced abilities became more obvious after 2 years of CI experience. The mean daily duration of CI use increased significantly from 7.8 ± 2.8 to 8.2 ± 2.7 h after 2 years. High numbers of daily coil disconnections were detected, with a significant mean decrease from 83.4 ± 73.1 to 66.3 ± 54.6 whereas the percentage exposure to different listening environments was widely stable over time. Significant rank correlations were identified between outcomes measured by ELFRA and CAP with daily duration of CI use, numbers of coil disconnections and percentage of exposure to speech-characterised listening scenes.

CONCLUSION

The auditory and language outcome in CI children with AD is variable, but it progresses over time. Children benefit from a consistent daily device use as well as from a high exposure to speech-characterised environments. Device use should be monitored constantly, with particular focus on daily duration of CI use and, in particular, on the number of coil disconnections if children have a severe motor impairment. Objective data-logging is an important addition to outcome assessment by testing, observations and parental questionnaires. Although assessment in children with AD is a major challenge for professionals, comprehensive assessment is needed to improve cochlear implant services with special adaption to children with AD, and this should include audiological, development-related and psychosocial information. A unified system to classify types of disabilities could help to improve procedures for analysing different outcomes.

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Long-term quality of life in children with complex needs undergoing cochlear implantation

OBJECTIVES

An estimated 30-40% of children undergoing cochlear implantation (CI) have additional disabilities and traditional outcome measures are often not reliable or appropriate. Few studies have evaluated long-term quality of life (Qol) in this group. Our aim was to assess long term QoL of children implanted with complex needs against a cohort of children implanted without. We also compared both groups for secondary outcome measures such as parental opinion, complications and hours of device wear.

METHODS

A retrospective casenote review of all children undergoing assessment between 2005 and 2010 was undertaken. Children with complex needs were identified using the Scottish Complex Needs Group Criteria (ISD 2006). Quality of life was measured using the GCBI (Glasgow Children's Benefit Inventory) which is a validated questionnaire suitable for the retrospective assessment of health-related QoL following paediatric surgical interventions. It consists of a 200-point scale which ranges from -100 (maximal harm) to +100 (maximal benefit) and can be analysed in four QoL subdomains (health, vitality, physical, learning). Parents were also asked to complete a simple questionnaire asking if they would recommend CI to other families and whether they would wish their child to undergo CI if given the option again.

RESULTS

174 children were implanted and 17 (10%) were found to have complex needs. Follow-up ranged from 4 to 9 years. Total GCBI scores were similarly high between groups but significantly higher scores were found in the emotion (p = 0.05) and learning domains (p = 0.03) in the complex needs group. Linear regression analysis was used to show that total GCBI score was not influenced by the number of categories of impairment (R² = 0.0123) in the complex needs group. All parents of children with complex needs said that they would proceed with implantation again or recommend to a friend. The complication rate in the complex needs group was higher (29 vs 15%), with device failure being particularly more common. Data-logging was consistent between both groups. A higher rate of development of significant other health issues that could affect outcome was found in the complex needs group (35% vs 8%).

CONCLUSIONS

Our study suggests that children with complex needs have comparable long-term QoL scores to those without and seem to particularly benefit in the domains of learning and emotion. Complications are higher in this group and there remains an increased risk of further development of medical conditions following early implantation, which may influence progress.

Outcomes of early intervention for deaf children with additional needs following an Auditory Verbal approach to communication

OBJECTIVES

To determine and compare the rates of progress made by pre-school aged children with all degrees and types of hearing impairment and deafness, both with and without additional needs as catalogued using SNOMED CT, at the end of a non-statutory programme of individualised Auditory Verbal (AV) intervention.

METHODS

An audit was conducted using a retrospective and comparative study design to examine spoken language outcomes in children who had spent more than two years on an AV programme and had completed their programmes between January 2007 and December 2017. The children were stratified according to i) whether they achieved age appropriate language (AAL) (n =102) or not (n =27); ii) whether they had deafness alone (n = 77) or deafness with additional needs (n =52); and iii) whether children with additional needs achieved AAL (n= 27) or not (n =25). Children undertook standardised spoken language assessments on joining the AV programme and then at intervals of at least 6 months for the duration of their programme. Derived measures of rates of language development (RLD) were used to compare the groups at i) the outset (initial RLD), and ii) the conclusion of the AV programme (programme RLD).

RESULTS

Overall, 79% of children within this cohort achieved age appropriate spoken language scores. Children with additional needs (40%) embarked on a non-statutory AV programme at a significantly older age (corrected for prematurity), with significantly lower initial RLD and, as a group, attained significantly lower programme RLD compared with children with deafness alone. One in two of the children with additional needs reached AAL by the end of their individualised programme. The children with additional needs also demonstrated a highly significant increase in their mean programme RLD compared with the mean initial RLD indicating an acceleration in acquiring spoken language competencies while on the AV programme.

CONCLUSIONS

For deaf children with additional needs who stay on an AV programme for more than two years, listening and spoken communication is significantly enhanced. Specific access to the AV approach in addition to generic, statutory early intervention could facilitate deaf children with additional needs to achieve or approach AAL. Ensuring families have access to effective early intervention increases the chances that i) a suitable communication approach is adopted at the earliest opportunity, and ii) a child with additional needs acquires listening and spoken language at a rate commensurate with their full potential. Applying the SNOMED CT framework as a means of categorising children's additional needs will enable more effective comparisons across studies from different centres around the world.