Rehabilitation and Psychosocial Determinants of Cochlear Implant Outcomes in Older Adults.

OBJECTIVE: The cochlear implant (CI) has been shown to be associated with better hearing, cognitive abilities, and functional independence. There is variability however in how much benefit each recipient derives from his or her CI. This study's primary objective is to determine the effects of individual and environmental characteristics on CI outcomes. DESIGN: Seventy-six adults who developed postlingual severe to profound hearing loss and received their first unilateral CI at 65 years and older were eligible for the study. Fifty-five patients were asked to participate and the 33 (60%) with complete data were classified as "group 1." The remaining patients were placed in "group 2." Primary outcomes included changes in quality of life and open-set speech perception scores. Independent variables included age, health status, trait emotional intelligence (EI), comfort with technology, and living arrangements. Survey outcomes and audiological measurements were collected prospectively at 12 months after surgery, whereas preoperative data were collected retrospectively. Comparisons between groups 1 and 2 were made. Wilcoxon signed rank test, Spearman correlations, Mann-Whitney tests, Chi-square tests, and linear regressions were performed only on group 1 data. RESULTS: Having a CI was associated with improved quality of life and speech perception. Familiarity with electronic tablets was associated with increased 12-month postoperative AzBio gains when adjusted for preoperative AzBio scores (adjusted p = 0.019), but only marginally significant when a family-wise error correction was applied (p = 0.057). Furthermore, patients who lived with other people scored at least 20 points higher on the AzBio sentences than those who lived alone (adjusted p = 0.046). Finally, consultation with an auditory rehabilitation therapist was associated with higher self-reported quality of life (p = 0.035). CONCLUSION: This study suggests that in a cohort of older patients cochlear implantation is associated with a meaningful increase in both quality of life and speech perception. Furthermore, it suggests the potential importance of adjunct support and services, including the tailoring of CI rehabilitation sessions depending on the patient's familiarity with technology and living situation. Investment in rehabilitation and other services is associated with improvements in quality of life and may mitigate clinical, individual and social risk factors for poor communication outcome.

Early literacy gains in children with cochlear implants.

OBJECTIVE: The purpose of this study was to investigate the predictors of emergent reading skills in children receiving early access to sound with a CI. STUDY DESIGN: Prospective case-control study. SETTING: Tertiary referral center. PATIENTS: Children who received their first cochlear implant (CI) before 24 months of age and had a minimum of 2 years experience. MAIN OUTCOME MEASURES: Receptive language skills as measured using the Reynell Developmental Language Scales or the Oral and Written Language Scales; early reading skills including alphabet, conventions, and comprehension skills assessed using the Test of Early Reading Abilities-3 (TERA-3); literacy behaviors in the home, socioeconomic status, and early intervention measures were explored on a parent questionnaire. RESULTS: Among 39 participants in the study, there was on average a 12-month delay in receptive language as compared with hearing peers. The study cohort as a group had age-appropriate reading scores. An inverse correlation was found between language delay and early reading performance. While accounting for language delay, girls on average performed better than boys. Daily reading at home and the use of open-ended questions during parent-child reading sessions were both associated with smaller language delays. CONCLUSION: The importance of verbal language to the development of early reading skills and vice versa is evident as is the important influence of literacy behaviors at home. Children with CIs can greatly benefit from intervention services that promote frequent exposure to books at home as well as the use of facilitative strategies during shared reading.