Cochlear Implants in Congenitally Deaf Children: A Discussion Built on Rights-Based Arguments.

The author discusses rights-based arguments for and against cochlear implants in congenitally deaf children and analyzes whether CIs should be required by law or left to parental discretion. Positions for and against CIs are analyzed in light of two rights-based arguments: Griffin's theory on personhood as a solution to a conflict of rights and his theory on quality of life as a solution to a conflict between rights and welfare (Griffin, 2008). The question of whether CIs should be required by law is then discussed in light of Nickel's theories on the justification of specific rights and on the avoidance of conflicts (Nickel, 2007). In this discussion, the author's aim is not to propose definitive answers, but to apply philosophical theories to the debate and introduce tools for analyzing arguments for and against CIs in children and for regulating cochlear implantation.

Performance on the standard and hearing-impaired Montreal Cognitive Assessment in cochlear implant users.

OBJECTIVES: Commonly used cognitive screening tools were not originally developed for patients with hearing loss (HL) and rely heavily on the ability to hear the instructions and test stimuli. Recently, the Montreal Cognitive Assessment (MoCA) was modified for use with hearing-impaired populations (ie, HI-MoCA). In order to investigate the clinical utility of the HI-MoCA, we assessed performance between the standard MoCA and HI-MoCA among postlingually deafened cochlear implant (CI) users. METHODS: We administered the standard MoCA and HI-MoCA to 21 CI users and compared their performance. We assessed differences in pass/fail status when items from the attention and language sections and the delayed recall task were removed. RESULTS: There was no significant difference in performance between the standard MoCA and HI-MoCA. Participants scored higher on both test versions when the delayed recall task was removed. Participants also performed better on the delayed recall task on the HI-MoCA than on the standard MoCA. CONCLUSIONS: While our findings suggest that the modality of presentation for the MoCA does not influence overall performance for postlingually deafened CI users, visual presentation of stimuli impacted performance on delayed recall. Furthermore, irrespective of presentation modality, our participants scored higher on both MoCA versions when the delayed recall task was removed. Clinically, modifications to the presentation of the MoCA might not be necessary for CI users; however, clinicians should be aware that the delayed recall task is inherently harder for these patients.

Self-assessment of daily hearing function for implant recipients: A comparison of mean total scores for the Speech Spatial Qualities of Hearing Scale (SSQ49) with the SSQ12.

OBJECTIVE: To assess the relationship and agreement between mean total scores for the Speech Spatial Qualities of Hearing Scale (SSQ49) and the shorter SSQ12 to measure daily hearing function for a large group of auditory implant recipients. METHODS: Prospective, longitudinal self-assessment by 1013 implant recipients using the SSQ49 at preimplant and at annual post-implant intervals (one, two and three-years) via an international registry. Mean total scores were calculated for the SSQ49 and the extracted SSQ12 responses. Pearson correlation and Bland-Altman agreement were examined between the SSQ49, SSQ12 and transformed SSQ12 versions. Longitudinal mixed-effects models were used to compare changes over time. RESULTS: Very high correlation was shown between mean total scores for all versions while perfect agreement was not reached. Clinically acceptable agreement (<1.0 unit) between all versions was obtained with the transformed SSQ12 being least biased. All versions showed statistically significant improvement at one-year post-implant (>2.2 units; p < 0.001). CONCLUSIONS: All scale-versions showed comparable sensitivity to changes in self-reported hearing function over time. TheSSQ12 may be considered as a potential time-efficient self-assessment of hearing function for implant recipients in routine practice. Further research may involve independent repeated administration of each scale version.

Effects of Age at Cochlear Implantation on Learning and Cognition: A Critical Assessment.

Purpose Age at cochlear implantation frequently is assumed to be a key predictor of pediatric implantation benefits, but outcomes related to learning and cognition appear inconsistent. This critical assessment examines relevant literature in an effort to evaluate the impact of age at implantation in those domains for individuals who received their devices as children. Method We examined 44 peer-reviewed articles from 2003 to 2018 considering age at implantation and conducted statistical analyses regarding its impact on several domains, including literacy, academic achievement, memory, and theory of mind. Results Across 167 assessments in various experiments and conditions, only 21% of the analyses related to age at implantation yielded evidence in favor of earlier implantation, providing greater benefits to academic achievement, learning, or cognition compared to implantation later in childhood. Among studies that considered cognitive processing (e.g., executive function, memory, visual-spatial functioning), over twice as many analyses indicated significant benefits of earlier implantation when it was considered as a discrete rather than a continuous variable. Conclusion Findings raise methodological, practical, and theoretical questions concerning how "early" is defined in studies concerning early cochlear implantation, the impact of confounding factors, and the use of nonstandard outcome measures. The present results and convergent findings from other studies are discussed in terms of the larger range of variables that need to be considered in evaluating the benefits of cochlear implantation and question the utility of considering age at implantation as a "gold standard" with regard to evaluating long-term outcomes of the procedure as a medical treatment/intervention for hearing loss. Supplemental Material https://doi.org/10.23641/asha.8323625.

Scar evaluation in subperiosteal temporal pocket versus the one-layer flap technique in cochlear implantation using the Patient and Observer Scar Assessment Scale.

PURPOSE: To compare the local and intracranial complications, migration of the IRS, surgical duration, and quality of life with the subperiosteal pocket technique and the one-layer flap (OLF) technique using the Patient and Observer Scar Assessment Scale (POSAS). METHODS: Eight patients who underwent cochlear implantation. The patients were applied subscales of the POSAS and were asked to respond to the questionnaire items via a telephone conservation conducted by a physician. Another researcher evaluated the patients' photographs using OSAS. POSAS was applied to the patients to compare the differences of scar assessment in subperiosteal pocket technique and the OLF technique. RESULTS: The surgical duration was 72.7 ± 12.3 min in the OLF group and 51.3 ± 11.7 min in the subperiosteal pocket group. The difference was statistically significant. No migration or intracranial complications were observed in either group. Patients in group 1 who underwent the subperiosteal technique were more satisfied than patients who received the OLF technique. However, there was no superiority between the two methods for the observer in scar assessment. CONCLUSION: Although the surgical time is longer, the lack of difference in terms of scar formation from smaller incisions, and few intra- and post-operative complications in experienced hands ensure that the OLF technique is a safe and reliable method in cochlear implantation surgery.

Satisfaction with Life among Mothers of Pediatric Cochlear Implant Candidates: The Impact of Implant Operation and Sociodemographic Factors.

OBJECTIVES: To evaluate the satisfaction with life among mothers of pediatric cochlear implant candidates regarding implant surgery and sociodemographic factors. MATERIALS AND METHODS: Mothers of 160 pediatric patients with profound sensorineural hearing loss who underwent unilateral cochlear implant surgery were included. A questionnaire form with items on sociodemographic-familial characteristics and Satisfaction with Life Scale (SWLS) was employed via face-to-face interview method before and 12 months after the implant surgery. RESULTS: The SWLS scores significantly improved after the implant surgery [from 19.1 (7.0) to 28.9 (4.0), p<0.000]. Being unemployed vs. employed [17.9 (6.9) vs. 24.0 (5.3), p=0.000], having another child with hearing disability [13.5 (5.7) vs. 19.7 (6.9), p=0.001], younger (12-24 months) vs. older (>24 months) age of the child at the time of implant surgery [7.1 (0.4) vs. 19.7 (6.6), p=0.001], absence vs. presence of regular follow-up visits [13.0 (0.0) vs. 19.4 (7.1), p=0.002], and presence vs. absence of change in social life after the diagnosis of disease [17.3 (6.5) vs. 20.9 (7.1), p=0.001] were associated with significantly lower SWLS scores among mothers. SWLS scores were positively correlated with patient's age at the time of implant surgery (r=0.206, p=0.009), whereas negatively correlated with the number of household members (r=-0.406, p=0.000) and number of children (r=-0.310, p=0.000). CONCLUSION: In conclusion, our findings revealed the association of cochlear implantation with a significant increase in mother's life satisfaction, despite the unemployment, presence of another child with hearing disability, and crowded household. Our findings emphasize on the consideration of family systems with special attention to mother's emotional experiences and occupational competence in the intervention programs.

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.

Assessment of early language development in Turkish children with a cochlear implant using the TEDIL test.

OBJECTIVES: To analyse language development of children with a cochlear implant (CI) in relation to length of CI use and age at implantation and to examine the suitability of the TEDIL as an assessment tool for measuring early language development in Turkish children. METHODS: A total of 119 children implanted with a CI before 5 years of age were assessed acutely on sound field thresholds, speech recognition thresholds, open-set and closed-set monosyllabic word tests, the TEDIL, categories of auditory performance (CAP), and speech intelligibility rating (SIR). The outcome scores were analysed in relation to length of CI use (3, 4, and 5 years) and age at implantation (<24 months vs. >24 months). The TEDIL scores were compared to all other outcome measures. RESULTS: Scores significantly increased with CI experience. CAP and SIR were significantly higher in the younger implanted group. No significant difference was observed between the younger and older implanted group on the closed-set and open-set monosyllabic tests and the TEDIL. The TEDIL scores significantly correlated with CAP, SIR, and the closed-set and open-set word scores. The mean TEDIL standard score was close to average. CONCLUSIONS: Performance of CI users improves with increased CI experience. CI users implanted <24 months tend to have better auditory skills and clearer speech than CI users implanted >24 months. CI users implanted between 24 months and 60 months tend to develop language similarly to CI users implanted <24 months. The TEDIL is a suitable tool for assessing early receptive and expressive language development in Turkish children.

Assessment of the psychosocial impacts of cochlear implants on adult recipients and their partners.

OBJECTIVES: In the present study we sought to evaluate the psychosocial and quality of life (QOL) impacts of cochlear implant (CI) treatment on both CI recipients and their partners in a Canadian population. METHODS: A qualitative cross-sectional contemporary cohort evaluation was conducted by distributing specifically designed questionnaires to both CI recipients and their partners at their follow-up appointments over a month at Sunnybrook Health Sciences Centre. RESULTS: It was found that both CI recipients and their partners demonstrated substantial benefit and improvement in multiple psychosocial domains. DISCUSSION: Musical listening was found to show variable improvements between recipients. Further analysis found a simple correlation where the group of recipients who all had a hearing disability for a longer duration had demonstrated a higher proportion of improvement in musical listening. CI recipients endorsed having improved QOL which was in agreement with proxy observation by partners. CONCLUSION: Overall, CI use has been shown to have significant benefit to psychosocial well-being of CI recipients. This benefit is also conferred to their caregivers/partners; which in our society concerned about caregiver burden is quite important to recognize.

Educational, employment, and social participation of young adult graduates from the paediatric Southern Cochlear Implant Programme, New Zealand.

OBJECTIVES: The purpose of this study is to observe the education and vocational achievements and social participation of cochlear implant recipients as they graduate from a paediatric cochlear implant programme and identify any significant associations that might exist. METHOD: This study identified 56 patients from the Southern Cochlear Implant Programme (SCIP) who received cochlear implants before the age of 19 (paediatric) and are now over the age of 19 (adult). A questionnaire investigated their education, employment, and identity with the hearing and deaf communities. Also included were the satisfaction with life scale and Hearing Participation Scale (HPS). Subjects ranged in age from 19 to 32. RESULTS: Twenty-six patients responded to the questionnaire, including one non-user. Twenty identified strongly or very strongly with the hearing community. There was weak evidence of a linear association between strong identity with the hearing community and a higher HPS score. No other statistically significant associations were detected. Interestingly, 12 out of 26 participants found employment through family. CONCLUSION: Positive outcome trends in education and employment were seen in this study although no statistical significance was achieved. There is a strong bias for those who use their cochlear implants regularly, and there are no data available for those who do not use their cochlear implants for comparison as only one non-user completed the survey, despite efforts to include this group. This study shows that there is perceived benefit in implantation for patients who use it regularly but further research is needed with a more diverse group of cochlear implant recipients.

The economic and societal benefits of adult cochlear implant implantation: A pilot exploratory study.

BACKGROUND: Cochlear implantation has been shown to result in significant improvements in communication and quality of life, but little is known about the effect of cochlear implantation and changes in a person's employment status and earning potential. The purpose of this study is to measure the extent to which personal income changes in people who receive a cochlear implant. METHODS: We mailed a survey to a random selection of 150 cochlear implantees who receive health services in a large urban setting. Of the 93 respondents, 65 were eligible for inclusion. Demographics, current income and income prior to implantation were recorded into income categories. RESULTS: With a 6.6-year mean duration from cochlear implantation, it was found that 31% of respondents had increased income enough to move income brackets, with a mean category rise of $10 021. Forty participants reported working pre-implant, while 49 reported working post-implant. IMPLICATIONS: Our results suggest preliminary evidence for an association between cochlear implantation and income. Increased accesses to cochlear implantation may provide opportunities for competitive employment and associated economic benefits for the individual, their families, and society.

Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3.

OBJECTIVES/HYPOTHESIS: To evaluate the changes in health-related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short-Form Survey-36 (SF-36) and the Health Utility Index Mark 3 (HUI-3). To do so, a health utility index was obtained by converting the SF-36 to the Medical Outcome Study Short-Form Survey-6D (SF-6D) to permit comparison with HUI-3 scores in the context of health preference as measured by quality-adjusted life years. STUDY DESIGN: Prospective cohort study. METHODS: Eighty-one postlingually deaf adult patients undergoing cochlear implantation completed the SF-36 and HUI-3 preoperatively and at a median of 1.4 years (range, 11 months-5 years) after cochlear implantation. RESULTS: The SF-36 improvement was statistically significant in two domains. The SF-36 data were converted to SF-6D. Preoperatively, the mean SF-6D utility score was 0.575 ± 0.056. One year postoperatively this score increased to 0.590 ± 0.064. The improvement of 0.015 ± 0.082 was not statistically significant (P = .1118). Of the HUI-3 attributes, two showed improvement between preoperative and postoperative evaluations. The overall HUI-3 score increased from 0.464 ± 0.207 preoperatively to 0.611 ± 0.190 postoperatively. The gain of 0.146 ± 0.19 was statistically significant (P < .0001). The intraclass correlation coefficient between the SF-6D and HUI-3 showed a very small correlation, both pre- and postoperatively. CONCLUSIONS: Against the backdrop of diminishing resources for healthcare, cost-effective analysis is fast becoming an important tool. There remains a strong need for health-related quality-of-life instruments that can truly reflect the benefit of cochlear implantation, in which utility estimates are fundamentally important. The SF-36 scores, when converted to SF-6D, do not correlate well with HUI-3 scores in a cohort of adult cochlear implant recipients. The HUI-3 remains the most appropriate tool for this patient group. LEVEL OF EVIDENCE: 4

Assessment of health-related quality of life 6 years after childhood cochlear implantation.

PURPOSE: To examine the impact of cochlear implant (CI) intervention on health-related quality of life (HRQOL) assessed by both self- and parent-reported measures. METHODS: In this national study of children implanted between ages 6 months and 5 years, HRQOL of 129 children 6-year post-CI was compared to 62 internal study (NH1) and 185 external (NH2) samples of hearing children frequency-matched to the CI group on sociodemographic variables. HRQOL ratings of children and their parents in each group, measured using the Child Health and Illness Profile-Child Edition, were compared, and their associations with the Family Stress Scale were investigated. RESULTS: CI children reported overall and domain-specific HRQOL that was comparable to both NH1 and NH2 peers. CI parents reported worse child scores than NH1 parents in Achievement, Resilience, and Global score (p's < 0.01) but similar or better scores than socioeconomically comparable NH2 parents. Higher family stress was negatively associated with all parent-reported HRQOL outcomes (p's < 0.01). Parent-child correlations in HRQOL global scores trended higher in CI recipients (r = 0.50) than NH1 (r = 0.42) and NH2 (r = 0.35) controls. CONCLUSIONS: CI recipients report HRQOL comparable to NH peers. These results, from both child and parent perspective, lend support to the effectiveness of CI intervention in mitigating the impact of early childhood deafness. Family stress was associated with worse HRQOL, underscoring a potential therapeutic target. Parent-child agreement in HRQOL scores was higher for CI families than NH families, which may reflect higher caregiver insight and involvement related to the CI intervention.

Psychological well-being among cochlear implant users: a comparison with the general population.

OBJECTIVES: In this study, we describe the psychological well-being experienced by cochlear implant users, and compare it to that of the general population in Norway. METHODS: We conducted a questionnaire-based cross-sectional multicentre study, in which 53 of 73 (73%) unilateral cochlear implant users and 177 of 318 (56%) matched reference subjects from the general population participated. Psychological well-being was measured by the Psychological General Well-being Index (PGWB). The indexes of the cochlear implant users and the general population sample were compared using ordinary linear regression, adjusting for the matching variables. RESULTS: Mean age of the cochlear implant users was 56 (SD 16) years, 66% of them were females, and they had used their implants for a mean of 18 (SD 6) months. The distribution of socio-demographic variables was similar to that of the general population sample. We found no difference in mean PGWB index between the cochlear implant users and the general population sample with indexes of 85.5 and 83.4, respectively. The 95% confidence interval for the adjusted difference was -3.0 to 6.9. The cochlear implant users had slightly better scores in the dimensions general health and vitality. DISCUSSION: The cochlear implant users experienced a psychological well-being similar to that of the general population.

Assessment of the subjective benefit of electric acoustic stimulation with the abbreviated profile of hearing aid benefit.

CONCLUSION: This study demonstrates that electric-acoustic stimulation (EAS) significantly decreases the subjective impairment in speech perception. OBJECTIVES: To assess the subjective benefit of EAS over the first 12 months after EAS fitting using the Abbreviated Profile of Hearing Aid Benefit (APHAB). METHOD: Twenty-three EAS users, implanted with either the PULSAR(CI)(100) FLEX(EAS) provided with the DUET EAS processor or the COMBI40+ Medium provided with the TEMPO+ speech processor, were included. Electric stimulation was activated about 1 month postoperatively; ipsilateral acoustic stimulation was added 2 months thereafter. EAS benefit was measured preoperatively with only a hearing aid and postoperatively at EAS fitting and then 3, 6 and 12 months after EAS fitting using the APHAB. RESULTS: Subjects reported significant improvements in the global score with a mean decrease in impairment from 74% preoperatively to 45% after 3 months of EAS use. Furthermore, clinical relevance was demonstrated in multiple subscales between preoperative and first fitting reflecting a true benefit of EAS with a probability of 95%.

Cochlear implantation in children: socioeconomic family characteristics.

PURPOSE: The aim of the study is to analyse the socioeconomic status of implanted children families, candidates for implantation families and families of deaf children whose parents elicit not to proceed with cochlear implantation and to find out if the socioeconomic status has an influence on parental decision-making process. The following variables describe the socioeconomic status: place of living (urban/rural area), parental educational level and household monthly income (in Euro). WORK METHOD: Forty children divided in two groups were included in the study: Group 1 (23 implanted children and 7 candidates for implantation) and Group 2 (10 deaf children whose parents elicit not to proceed). Data were obtained from parents of children by phone. It was not possible to establish the contact with parents of three children. WORK RESULTS: As for the place of living, 20 families were from urban area, 17 families were from rural area and the place of living of 3 families was unknown. Average number of completed school grades by parents was respectively: Group 1- 5.92 and Group 2 - 5.33. CONCLUSION: Concerning the place of living, parental educational level and household monthly income no differences can be seen between groups. Therefore, the authors concluded that socioeconomic status has no influence on making decision process.

How Japanese parents of deaf children arrive at decisions regarding pediatric cochlear implantation surgery: a qualitative study.

In recent years, many children with severe or profound congenital hearing loss have undergone treatment to receive cochlear implants; however, the efficacy and risks associated with pediatric cochlear implants are still unknown. Some deaf adults are opposed to parents making the decision regarding cochlear implants for their children. To elucidate the benefits and risks perceived by parents and to investigate parents' decision-making processes, we interviewed 26 parents of deaf children (aged 12 years or younger) who live in the wider Tokyo area, Japan. The results showed that the participants perceived auditory and speech improvements as benefits. On the other hand, participants pointed out various risks associated with cochlear implantation such as medical complications, restrictions on daily activities, cost of cochlear implant upgrades, low effectiveness, and the negative psychosocial impact associated with the implants. Participants who emphasized the benefits of the surgery tended to approve of cochlear implants. Participants who emphasized the risks of the surgery tended to disapprove. All participants, however, were reluctant to make the decision to undergo cochlear implants on behalf of their children due to the uncertain benefits and risks. Participants who believed that early implantation during infancy would be associated with better outcomes regarded their surrogate decision-making as necessary and approved the treatment. This decision, however, was made with certain stipulations; for example, these parents resolved to discuss the decision with their children as they got older, and would give their children the option of having the implant removed. Those who did not believe claims about the effectiveness of early implantation postponed decision-making. These results suggest that guardians face difficulty in decision-making and need information and support from various professionals, deaf adults, parents of children with implants, and children with implants themselves.

Willingness-to-pay for pediatric cochlear implantation.

OBJECTIVE: This paper presents the results of the first willingness-to-pay (WTP) study to be undertaken on cochlear implantation. It aims to measure the values parents place on the UK having a pediatric cochlear implantation (PCI) programme. METHODS: Face-to-face semi-structured interviews were conducted with parents of children from the Nottingham Pediatric Cochlear Implant programme, whom had been implanted for a period ranging from 1 month to 13 years. Parents willingness-to-pay for the UK to have a pediatric cochlear implantation programme were elicited using a bidding process question format and via a discrete choice question. To see if income was a significant determinant of willingness-to-pay an analysis of variance (ANOVA) was undertaken in the statistical package SPSS version 10. RESULTS: Two hundred and sixteen parents were interviewed over the period July 2001-August 2002, representing over 130h of interviewing. The mean and median willingness-to-pay values elicited were UK pound 127 and 50 per month, respectively (UK pound 2001/2002). Willingness-to-pay was positively related to income (P<0.020). When the income constraint was removed, 99% of parents choose the implant over having the money the implant would cost to spend in some other way to benefit their child. CONCLUSIONS: Parents of implanted children were willing to pay substantial monthly amounts for pediatric cochlear implantation. Most parents saw no alternative to pediatric cochlear implantation that could improve their child's quality of life to the same extent. Willingness-to-pay was sensitive to income as expected suggesting that the values elicited are both valid and influenced by a respondent's budget constraint.

The assessment and treatment of deaf children with psychiatric disorders.

The assessment and treatment of deaf children with psychiatric disorder is intimately related to the individual child's communication, which in turn is affected by a number of factors, medical, social, and cultural. The deafness can be aetiologically related to the psychiatric disorder or can be incidental. Treatment strategies should be adapted to meet the individual child and family's needs. Deaf professionals have a vital role in mental health services for this population. The use of an interpreter can clarify communication and cultural issues for deaf and hearing children, families, and professionals.