Illness perceptions in cochlear implant users - a longitudinal study.

PURPOSE: 'Illness perceptions' refers to the thoughts and ideas a person has about an illness. According to Leventhal's Self-Regulatory Model (SRM), changing the threatening illness perceptions of cochlear implant (CI) recipients can be a further step in optimizing hearing outcomes with the CI. The aims of the present study were to assess users' illness perceptions and to determine whether perceptions change during six months of CI rehabilitation. METHODS: One hundred and thirty-eight participants completed the Brief Illness Perception Questionnaire (Brief IPQ), assessing their illness perceptions on nine scales. Data were collected at a German CI center at first CI fitting and six-month follow-up. After first fitting, participants underwent intensive rehabilitation including auditory training, medical, audiological and psychological treatments. RESULTS: At both assessments, participants tended to view their hearing impairment as a severe threat. On the Brief IPQ, the 'consequences' assessment improved during CI rehabilitation, which can be explained by the CI-induced hearing improvement. However, 'understanding' and 'identity' assessments worsened. This could be because CI recipients only come to realize the full complexity of their hearing impairment during rehabilitation. The other scales and the total score remained unaffected. CONCLUSIONS: Current practice in CI rehabilitation seems to be insufficient to improve threatening illness perceptions (except for perceived consequences). This may be because standard information often fails to reach the patients. The development and empirical validation of an intervention program to address individual illness perceptions in CI recipients could be helpful in this context. Further research will be needed to confirm the results.

Associations between illness perceptions, word recognition, and perceived sound quality in cochlear implant users.

OBJECTIVE: Illness perceptions refer to thoughts and ideas an individual has about an illness. The aim was to understand how cochlear implant (CI) users' illness perceptions, in addition to their monosyllabic word recognition abilities, are associated with their self-perceived sound quality. DESIGN: Data were collected during routine CI check-up appointments. Participants completed the Brief Illness Perception Questionnaire (assessing their illness perceptions) and the Hearing Implant Sound Quality Index (assessing their subjective sound quality). Additionally, monosyllabic word recognition abilities were measured with the Freiburg Monosyllable Word Test. Hierarchical regression analysis were utilised to model users' sound quality ratings. Participants' age was entered first as a control variable. In the next step, monosyllabic word recognition was entered. Finally, participants' illness perceptions were entered. STUDY SAMPLE: Fifty-five participants with unilateral CI provision. RESULTS: Monosyllabic word recognition was significant in the second step. When illness perceptions and monosyllabic word recognition were both included in the third step, illness perceptions, but not monosyllabic word recognition, were significant. The model explained 22% of the variance of subjective sound quality. CONCLUSIONS: Monosyllabic word recognition abilities and illness perceptions of CI users are important for their self-reported sound quality, but illness perceptions appear to be potentially more relevant.

[Early language performance in the ELFRA questionnaire : Analysis of multicentre data from children with bilateral cochlear implants]. / Frühe Sprachleistungen im Fragebogen ELFRA : Auswertung multizentrischer Daten von Kindern nach bilateraler Cochleaimplantatversorgung.

BACKGROUND: Very early bilateral cochlear implant (CI) provision is today's established standard for children. Therefore, the assessment of preverbal and verbal performance in very early stages of development is becoming increasingly important. Performance data from cohorts of children were evaluated and presented based on diagnostic assessment using chronological age (CA) and hearing age (HA). METHODS: The present study, as part of a retrospective multicentre study, included 4 cohorts (N = 72-233) of children with bilateral CI without additional disabilities. Their results in the German parent questionnaires Elternfragebögen zur Früherkennung von Risikokindern(ELFRA­1 and ELFRA-2) subdivided for CA and HA were statistically analysed. The data were also analysed in terms of mono-/bilingualism and age at CI provision. RESULTS: Overall, verbal performance in relation to CA was lower than in relation to HA. Preverbal skills were largely CA appropriate. Children with bi-/multilingual language acquisition performed significantly lower. Verbal performance in ELFRA­2 referenced to CA was negatively correlated with age at CI provision. CONCLUSION: In the case of early CI provision, CA should be the preferred reference mark in preverbal and verbal assessment in order to obtain exact individual performance levels and avoid bias in results. The percentiles determined are of limited use as generally valid reference values to which the individual performance of bilaterally implanted children could be compared. Further multicentre studies should be initiated.

[The LittlEARS® Auditory Questionnaire : An analysis of multicentre data of children after early bilateral cochlear implant placement]. / Der LittlEARS® Hörfragebogen : Auswertung multizentrischer Daten von Kindern nach früher bilateraler Cochleaimplantatversorgung.

BACKGROUND: In order to optimise the support of children with cochlear implants (CI), it is very important to detect slow developmental processes as early as possible. Data from the LittlEARS® Auditory Questionnaire (LEAQ) from children with early bilateral CI are evaluated and presented in relation to age and hearing age and compared with language development data recorded later. MATERIALS AND METHODS: This retrospective multicentre study included data from a total of 554 children for whom at least one LEAQ was completed during the course of CI rehabilitation. Children without additional disabilities who received bilateral simultaneous or sequential CI treatment were included. RESULTS: As expected, there are high correlations between hearing age (HA) and the overall LEAQ total score. When analysed according to chronological age (CA), development runs roughly parallel to the development of children with normal hearing, albeit at a lower level. Children implanted early up to an age of ≤ 12 months consistently achieve approximately 7-8 raw points more. Only the LEAQ results of the later test times (from the age of 18 months) correlate with some areas of the speech development test for children (SETK; areas 3-5). CONCLUSION: The earliest possible detection of critical developmental processes in children with CI is extremely important. In the case of very early CI fitting, the CA should be used as a reference measure in diagnostics. The LEAQ values determined for the group of children with CI are suitable to a limited extent as generally valid reference values for children with early bilateral CI. Further studies should continue to work out the correlations between early preverbal development and later speech development.

[Word production in children with cochlear implant based on chronological age and hearing age]. / Hör- und Lebensalter-bezogene Wortproduktion von Kindern mit Cochlea-Implantat.

BACKGROUND: For congenitally deaf children, an early bilateral provision with cochlear implant (CI) is a favourable condition for language acquisition. The objective of the present study was to determine the word production in CI children. The focus was on a comparison of chronological age and hearing age performance and on the evaluation of potential effects of multilingualism, additional disabilities and age at provision. METHODS: The data of 62 children with bilateral CI (age at provision in months M=12,1; SD=6,2) were retrospectively analysed. Vocabulary was assessed by the test Aktiver Wortschatztest für 3- bis 5-jährige Kinder - Revision and compared for chronological age and hearing age. Group comparisons and correlation analysis was conducted regarding multilingualism, additional disabilities and age at provision. RESULTS: The cohort performed significantly better when referenced to hearing age: level were within or above the norm in more than 50%; referenced to chronological age in around 37%. The descriptive performance differences for multilingualism and additional disabilities were only significant for children with both characteristics. Performance of monolingual children without additional disabilities was not significantly associated with age at provision. CONCLUSION: CI children may achieve an adequate expressive vocabulary at the age of 3 to 5 years. Multilingualism and additional disabilities seem to be particular challenges for CI children and need a more precise definition in further studies. The use of both chronological and hearing age as reference marks allows a differentiated assessment of the language status. This may lead to benefits in therapeutic interventions and parent councelling.

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.

Age-related language performance and device use in children with very early bilateral cochlear implantation.

OBJECTIVES: Paediatric cochlear implantation within the first year of life results in better outcome in auditory and language skills. Beside individual, audiological and social factors, quantity and quality of daily cochlear implant (CI) use also seem to be an influencing factor. The purpose of this study was to evaluate children's early receptive and expressive language performance considering bilingual language development as well as quantity and quality of daily CI use and intraoperative objective measurements. METHODS: The retrospective analysis included data from 35 very early bilaterally cochlear-implanted children (age at CI M = 8.4 ± 1.5 months). Language performance was assessed by the German standardised test SETK-2 (age at testing M = 29.4 ± 4.0 months). The CI system-integrated data-logging was analysed with regard to daily CoilOn-time, CoilOff and exposure to classified listening scenes. Intraoperatively measured thresholds of evoked compound action potentials (T-ECAPs) were analysed to ensure CI functionality. RESULTS: The cohort showed language performance within the normal range for word comprehension, sentence comprehension and word production, level of sentence production was reduced. Overall, bilingual children performed less well than monolingual children. Intraoperative T-ECAPs were recorded for the total cohort and no anomalies were detected. Children used their CI for about 8.7 ± 1.4 h per day, most of this time spent in a quiet environment (38%). Word production was significantly correlated with the daily duration of CI use (CoilOn-time) and with exposure to the listening environment Speech. No correlation was found between number of daily coil disconnections (CoilOff) and language performance. CONCLUSION: Very early bilateral cochlear implantation may result in age-appropriate language skills already at the age of 2 years. Monolingualism seems to a better condition for early language development with CI than bilingualism. Especially for word production, the daily duration of CI use and exposure time in a speech-characterised environment seem to be additional positive factors. Monitoring the data-logs should be one important focus of professionals during the postoperative rehabilitation process to detect potential benefits and risks. These findings should be integrated into rehabilitative therapy and parent counselling.