Familial psychosocial impact of cochlear implantation.

BACKGROUND: Adult cochlear implantation rates are increasing, and the resulting change in hearing capabilities has vast impacts in the psychosocial domain of life for the cochlear implant users and their families. However, there is currently no published evidence synthesis of the ways in which adult cochlear implantation affects the psychosocial sphere of the family unit. OBJECTIVE: (1) Describe the existing literature on the psychosocial impact of cochlear implantation on adults. (2) Assess the range of impacts on the family unit and highlight areas warranting further investigation. DATA SOURCES: Ovid, CINAHL, and Scopus. REVIEW METHODS: Databases were systematically searched from January 1, 2007 to May 1, 2022. Eligibility assessment was performed via two independent investigators. Disagreements in selection were discussed and consulted on with a third investigator as needed. RESULTS: Of the 875 unique articles identified, 13 remained in the final review. The most frequently noted psychosocial impacts on the family was quality of life (100 %), family relations (85 %), conversational access (85 %), everyday hearing (77 %), and less feelings of isolation (77 %). 6 of the studies only considered the viewpoint of the CI user and did not have a congruent survey response from an individual from their family unit. CONCLUSION: This study describes the existing literature on the familial psychosocial impact of adult cochlear implantation, focusing on the general well-being, social integration, and psychological aspects noted post-implantation. This review identifies gaps in this research, with large numbers of studies on CI user benefits and little insight into the impact on the family unit. We recommend shifting research on CI impact toward a focus on the family unit, rather than individual, and an evaluation of familial influence in electing to receive a CI.

Response shift in hearing related quality of life after cochlear implantation - effect size and clinical significance: a then-test study.

BACKGROUND: Quality of life questionnaires are often used in the assessment of rehabilitation of hearing-impaired patients with a cochlear implant. However, a prospective study with a systematic retrospective evaluation of the preoperative quality of life after surgery has not yet been conducted and may reveal a change in internal standards, such as a response shift, due to the implantation and hearing rehabilitation. METHODS: The Nijmegen Cochlear Implant Questionnaire (NCIQ) was used for assessing hearing related quality of life. It has three general domains (physical, psychological and social) and six subdomains. Seventeen patients were tested before (t0) and retrospectively (then-test; pre-t1) and acutely postoperative (post-t1) after cochlear implantation. Observed changes, then-test changes, response shifts and effect sizes were calculated. Non-parametric statistical methods were used. RESULTS: The NCIQ total score was 52.32 ± 18.69 (mean, standard deviation) for t0, 59.29 ± 14.06 for pre-t1 and 67.65 ± 26.02 for post-t1 questioning. The observed change was statistically significant in all domains but in speech production. Response shift was statistically significant in the total score and in part of the domains. The effect sizes for the response shift were moderate (> 0.5) in the total score, psychological, social general scores and subdomains. CONCLUSIONS: In this study we found that response shift does exist in adults with severe to profound hearing loss undergoing cochlear implantation. By advising the participants to deactivate the implant for the then-test, recall bias and noise were minimized. The clinical significance of the response shift was present in the total score and in the social and psychological domains. TRIAL REGISTRATION: This study was retrospectively registered with the German Clinical Trial Register, TRN DRKS00029467, on 07/08/2022.

Depression, Anxiety, and Quality of Life in Patients with Cochlear Implant: A Case-Control Study.

BACKGROUND: It is known that there is a relationship between hearing loss, which is an important cause of disability, psychological symptoms, and low quality of life. The aim of this study is to evaluate the anxiety, depression levels, and quality of life analysis of adults with postlingual hearing loss and who have undergone cochlear implants and to compare them with the data of subjects who have never had a hearing loss. METHODS: The prospective controlled clinical study included 53 subjects who had cochlear implants and 52 healthy controls in terms of hearing. Hospital Anxiety and Depression Scale and Short Form 36 were filled by all subjects to investigate their depression, anxiety, and quality of life levels. RESULTS: The mean age of subjects was 42.88 ± 18.04, and 44% (23) were women. There was no significant difference between the study and control groups in terms of Hospital Anxiety and Depression Scale scores. Short Form 36 physical role (P = .018) and SF-36 general health (P = .014) in quality of life assessment sub-scores were statistically significantly higher in the study group than in the control group. When the correlation between the time elapsed after surgery and Hospital Anxiety and Depression Scale scores and Short Form 36 scores was evaluated, no significance was observed. CONCLUSION: The fact that the patients evaluated after cochlear implant surgery had similar depression and anxiety levels and quality of life as the controls, and even physical role and being significantly better in general health compared to the controls reveal the importance of regaining the hearing ability.

Changes in cognitive performance after cochlear implantation in adults and older adults: a systematic review and meta-analysis.

OBJECTIVES: To conduct critical assessment of the literature on the effects of cochlear implantation on adults' cognitive abilities. DESIGN: PubMed, Scopus, Lilacs, Web of Science, Livivo, Cochrane, Embase, PsycInfo, and grey literature were searched. Eligibility criteria: age 18 or over with severe-to-profound bilateral hearing loss, cochlear implantation, cognitive test before and after implantation. Risk of bias was assessed using ROB, ROBINS-I and MASTARI tools. Meta-analysis was performed. STUDY SAMPLE: Out of 1830 studies, 16 met the inclusion criteria. RESULTS: On AlaCog test, significant improvement was found after implantation [MD = -46.64; CI95% = -69.96 to -23.33; I2 = 71%]. No significant differences were found on the Flanker, Recall, Trail A and n-back tests (p > 0.05). For MMSE, no significance was found [MD 0.63; CI 95% = -2.19 to 3.45; I2 = 88%]. On TMT, an overall significant effect with a 9-second decrease in processing speed post-implantation [MD = -9.43; CI95% = -15.42 to -3.44; I2 = 0%]. CONCLUSION: Cognitive improvements after cochlear implantation may depend on time and the cognitive task evaluated. Well-designed studies with longer follow-up are necessary to examine whether cochlear implantation has a positive influence on cognitive abilities. Development of cognitive assessment tools to hearing-impaired individuals is needed.

Parents' Perspectives on the Outcome of Cochlear Implantation for the Deaf Child and the Family in Saudi Arabia.

The researchers investigated parents' perspectives on the outcome of cochlear implantation on the deaf child and the family in Saudi Arabia with respect to linguistic, social, psychological, and educational aspects. They also explored potential factors influencing parents' perspectives on the outcome of a cochlear implant (CI). Seventy-seven parents completed the questionnaire, and multiple linear regression and descriptive statistics were used to answer the research questions. Most of the parents (88.5%) reported choosing a CI for their deaf child because they wanted their child to be part of the hearing world. About half of the parents (49.4%) expressed the belief that the CI would help their child find a better job in the future. The study also found that, overall, the model was not significant, and the independent variables explained little of the variance in parents' perspectives on the outcome of their child's cochlear implantation.

Effect of cochlear implantation on cognitive decline and quality of life in younger and older adults with severe-to-profound hearing loss.

PURPOSE: (a) To measure the change in cognition, the improvement of speech perception, and the subjective benefit in people under and over 60 years following cochlear implantation. (b) To assess the relationship between cognition, demographic, audiometric, and subjective outcomes in both age groups. METHODS: 28 cochlear implant (CI) users were assigned to the < 60y group and 35 to the ≥ 60y group. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals (RBANS-H); subjective benefit was measured using the Nijmegen Cochlear Implant Questionnaire (NCIQ); the Glasgow Benefit Inventory (GBI); the Hearing Implant Sound Quality Index (HISQUI19); Speech, Spatial and Qualities of Hearing Scale (SSQ12); and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Prior to surgery: the RBANS-H total score positively correlated with the domains "Advanced sound", "Self-esteem", and "Social functioning" of NCIQ, and negatively with HADS scores. 12 months post-implantation: the RBANS-H total score increased in the < 60y (p = 0.038) and in the ≥ 60y group (p < 0.001); speech perception and subjective outcomes also improved; RBANS-H total score positively correlated with "Self-esteem" domain in NCIQ. Age and the RBANS-H total score correlated negatively in the ≥ 60y group (p = 0.026). CONCLUSIONS: After implantation, both age groups demonstrated improved cognition, speech perception and quality of life. Their depression scores decreased. Age was inversely associated with cognition.

Implicit learning of non-verbal regularities by deaf children with cochlear implants: An investigation with a dynamic temporal prediction task.

Some deaf children continue to show difficulties in spoken language learning after cochlear implantation. Part of this variability has been attributed to poor implicit learning skills. However, the involvement of other processes (e.g. verbal rehearsal) has been underestimated in studies that show implicit learning deficits in the deaf population. In this study, we investigated the relationship between auditory deprivation and implicit learning of temporal regularities with a novel task specifically designed to limit the load on working memory, the amount of information processing, and the visual-motor integration skills required. Seventeen deaf children with cochlear implants and eighteen typically hearing children aged 5 to 11 years participated. Our results revealed comparable implicit learning skills between the two groups, suggesting that implicit learning might be resilient to a lack of early auditory stimulation. No significant correlation was found between implicit learning and language tasks. However, deaf children's performance suggests some weaknesses in inhibitory control.

Parents' Perspectives on Cochlear Implantation Results for Deaf Children or Children With Hearing Loss in Saudi Arabia.

The purpose of the research was to understand the quality of life of children from Saudi Arabia with cochlear implants (CIs) from the parental perspective in terms of communication abilities, social skills, academic achievement, being well adapted for future life, rehabilitation knowledge, and stress due to hearing loss. A quantitative approach was used, in which a questionnaire was administered to 103 children with CIs. The results showed high levels of expectations with respect to communication abilities, social skills, academic achievement, being well adapted for future life, and rehabilitation knowledge. The parents were observed to be highly stressed by their children's disability. Pearson's correlation and linear regression analysis were used to test the association of the characteristics of the implanted children on factors of quality of life.

Do patients report quality of life improvements after fitting of their unilateral bone conducting hearing implant?

OBJECTIVE: The audiological benefits of a bone conducting hearing implant are well documented; however, there is a paucity of literature comparing pre- and post-operative quality of life benefits. This study assessed the quality of life status before and after the device is implanted. METHODS: A prospective study was conducted of all adult bone conducting hearing implants inserted in a teaching hospital between 2012 and 2017. All patients completed the Glasgow Health Status Inventory, a validated quality of life questionnaire, before and three to six months after implantation. RESULTS: Sixty-two patients received a unilateral bone conducting hearing implant. All scores except the social score improved post-operatively. The paired t-test showed that the differences in the means for the Glasgow Health Status Inventory total, general and physical scores were statistically significant at the 5 per cent level (p < 0.0001). CONCLUSION: This study, one of the few to assess quality of life pre- and post-implantation, showed a vast improvement in patients' perceived quality of life from the pre- to the post-operative phase.

Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults.

Cochlear implants (CI) have increasingly been adopted in older adults with severe to profound sensorineural hearing loss as a result of the growing and aging world population. Consequently, researchers have recently shown great interest in the cost-effectiveness of cochlear implantation and its effect on quality of life (QoL) in older CI users. Therefore, a systematic review and critical evaluation of the available literature on QoL in older adult CI users was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching MEDLINE (PubMed) and the Cochrane Library and by checking the reference lists of relevant articles. Inclusion criteria were as follows: (1) the study sample were adults aged 50 years and older with postlingual onset of bilateral severe to profound hearing loss, (2) all subjects received a multi-electrode CI, and (3) QoL was assessed before and after implantation. Out of 1,093 records, 18 articles were accepted for review. Several studies demonstrated significant positive effects of cochlear implantation on QoL in older adults, but high-level evidence-based medicine is lacking. An improvement of QoL was generally reported when using disease-specific instruments, which are designed to detect treatment-specific changes, whereas the outcomes of generic QoL questionnaires, assessing general health states, were rather ambiguous. However, only generic questionnaires would be able to provide calculations of the cost-effectiveness of CI and comparisons across patient populations, diseases, or interventions. Hence, generic and disease-specific QoL instruments are complementary rather than contradictory. In general, older CI users' QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. There is a need for a standardized, multidimensional, and comprehensive QoL study protocol including all relevant generic and disease-specific instruments to measure and compare QoL, utility, and/or daily life performance in CI users.

Benefits of Cochlear Implantation in Middle-Aged and Older Adults.

INTRODUCTION: Nowadays cochlear implantation (CI) is the treatment of choice in adults in case conventional hearing devices fail. Besides speech perception, an improvement in quality of life and in cognitive performance has been reported. Thereby, the study focused on the impact of age. PARTICIPANTS AND METHODS: Thirty middle-aged (MA) between 50 and 64 years and 41 older subjects (OA) aged 65 and older with bilateral severe hearing loss performed a comprehensive computer-based neurocognitive test battery (ALAcog) pre- and 12 months post-implantation. Besides, monosyllabic speech perception in quiet (Freiburg monosyllabic speech test), health-related quality of life (HR-QoL, Nijmegen Cochlear Implant Questionnaire) and depressive symptoms (GDS-15) have been assessed. RESULTS: Both age groups significantly improved in all three categories after 12 months. No differences were evaluated between MA and OA regarding speech perception and HR-QoL pre- and post-operatively. In contrast, cognitive performance differed between the age groups: pre-operatively OA performed worse in most neurocognitive subdomains like working memory (p=0.04), inhibition (p=0.004), processing speed (p=0.003) and mental flexibility (p=0.01), post-operatively MA outperformed OA only in inhibition (p=0.01). Age only slightly influenced cognitive performance in MA, whereas in OA age per se tremendously impacted on working memory (p=0.04), inhibition (p=0.02), memory (p=0.04) and mental flexibility (p=0.01). Educational level also affected processing speed, mental flexibility (p=0.01) and working memory (p=0.01). This was more pronounced in OA. In both age groups, hearing status had a strong effect on attentional tasks (p=0.01). In MA, depressive symptoms were more influential on cognitive functioning and on HR-QoL than in OA. Improvement in quality of life (p=0.0002) and working memory (p=0.001) was greater for those with a higher pre-operative depression score. CONCLUSION: Speech perception and HR-QoL improved in hearing impaired, independently of age. Pre-operative differences in cognitive performance between OA and MA clearly attenuated 12 months after CI. Impact of comorbidities differed between age groups.

Quality of life (QoL) evaluation of children using cochlear implants: agreement between pediatric and parent proxy-QoL reports.

Objectives: Cochlear implants are known to significantly improve the quality of life (QoL) of implanted children. However, variability exists between self-reported outcomes and parental-reported QoL questionnaires. We evaluated the QoL agreement between children and their parents following cochlear implantation and determined which factors lead to increased agreement. Methods: A cross-sectional study was performed including pediatric cochlear implant recipients and their parents. We evaluated postoperative QoL using The Pediatric Quality of Life Inventory (PedsQL). To assess agreement between pediatric and parental QoL perception, PedsQL intra-class correlations (ICCs) were calculated. Results: Thirty-five children and their parents completed QoL questionnaires. Children who were evaluated between 8-12 years of age reported highest absolute total and subscale PedsQL scores. Highest agreement was found amongst parents and children when: (1) children were between 8-12 years at QoL assessment (ICC: between 0.917[95%CI: 0.676-0.981] and 0.972[95%CI: 0.882-0.994]), and (2) when evaluating the physical health QoL domain (ICC: 0.964[95%CI: 0.849-0.992]). Conclusions: This study demonstrates high agreement (ICC > 0.8) between pediatric and parental QoL report in children aged between 8-12 years at QoL assessment. Therefore, results confirm that: (1) QoL agreement between pediatric self-report and parent proxy-report is high in chronically ill children and (2) children using cochlear implants can reliably report QoL between 8-12 years.

Parent reported barriers and facilitators towards cochlear implantation - A systematic review.

CONTEXT: Early identification and intervention of hearing loss at a young age leads to long term benefits from language, communication, social, educational and financial aspects. Cochlear implantation is a widely recommended rehabilitation option for hearing loss. The process of cochlear implantation is a long one and the role played by parents is crucial. OBJECTIVE: The present systematic review was carried out with the aim of identifying the different parent reported barriers towards cochlear implantation. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Cochrane Library. STUDY SELECTION: Studies in parent reported barriers towards cochlear implantation screened and identified using 3 stages by 2 reviewers. Mixed Methods Appraisal Tool was used to carry out the quality appraisal of included studies. DATA EXTRACTION: Outcome measures related to barriers and facilitators. RESULTS: Nineteen studies were identified and included in the present review which discussed the parent reported barriers based on themes such as service delivery, social issues, time related, device/surgery, financial, child related and others. The different factors that facilitated the process included availability of resources, finances, child related and parental. CONCLUSION: The present review was a novel attempt at exploring the different parent reported barriers towards cochlear implantation. The facilitators, which can be used to overcome these barriers, will be useful for making the process smoother.

Adults' cochlear implant journeys through care: a qualitative study.

BACKGROUND: Cochlear implants (CIs) can provide a sound sensation for those with severe sensorineural hearing loss (SNHL), benefitting speech understanding and quality of life. Nevertheless, rates of implantation remain low, and limited research investigates journeys from traditional hearing aids to implantable devices. METHOD: Fifty-five adults (≥ 50 years), hearing aid users and/or CI users, General Practitioners, and Australian and United Kingdom audiologists took part in a multi-methods study. Focus groups, interviews, and surveys were thematically analysed. RESULTS: One hundred forty-three data-capture events disclosed 2 themes: 1) "The burden of hearing loss and the impact of Cochlear Implants", and 2) "Professional Support and Practice, and HCPs Roles and Responsibilities". CONCLUSIONS: Care experience can include convoluted, complex journeys towards cochlear implantation. The significant impact of this, as hearing loss progresses, motivates people to consider implants, but they and healthcare professionals need clear supported with defined referral pathways, and less system complexity.

What can we learn from adult cochlear implant recipients with single-sided deafness who became elective non-users?

Objective: This retrospective study investigates the incidence of elective cochlear implant (CI) non-use amongst a cohort of adult CI recipients with single-sided deafness (SSD), identifies the causes that led to non-use, and assesses how non-use could be prevented. Methods: All adults with SSD who received a CI between 2008 and 2018 and who became elective CI non-users were included. Elective non-users were defined as CI recipients who decided to stop using their CI or, if explantation was necessary, refused reimplantation. Results: 5/114 (4.4%) adults with SSD who received a CI became elective non-users. The 5 non-users were a mean 44.2 years old (range 33-70 years) at implantation, had a mean duration of deafness of 7.1 years (range 0.5-20 years) at implantation, and used their CI for a mean 11.5 months (range 1.5-60 months) before (fully) discontinuing use. The primary cause of elective non-use was postoperative discouragement due to unrealistic expectations (4 participants) regarding sound perception with the CI or about the greater than expected level of commitment necessary for rehabilitation. Conclusions: Elective non-use among adult CI recipients with single-sided deafness was very rare and could be further prevented by comprehensive counselling to ensure that candidates have realistic expectations about the rehabilitation requirements and the outcomes with the CI.

Health related quality of life in adolescent cochlear implant users.

Objective: Children with significant hearing loss (HL) are at risk for lower self-esteem and lower perceived quality of life (QoL). This study examined how self-reported QoL of adolescents cochlear implant (CI) users compared to that of adolescents with normal hearing, and examined if factors such as socioeconomic status (SES) and communication methodology affect QoL and speech recognition. Methods: Forty-three adolescent CI users completed a 34-item questionnaire that included questions adapted from the QoL of Deaf or Hard-of-Hearing Youth questionnaire (Seattle Quality of Life Group SEAQOL. 2010 Quality of life of deaf or hard-of-hearing youth (YQOL-DHH). Seattle, Washington) and from the Kidscreen-10 Index (The KIDSCREEN Group, Europe, 2006, the KIDSCREEN questionnaires - quality of life questionnaires for children and adolescents handbook. Lengerich: Pabst Science Publishers. All subjects received their first CI prior to the age of 5, and ranged in age from 10-17 years at the time of survey completion. Results: Adolescents with CIs demonstrated self-reported QoL scores similar to children with normal hearing. Lower SES and communication mode appear to influence speech recognition, and also appear to impact self-reported QoL in different ways. Conclusions: Examination of communication outcomes, along with other factors that influence QoL, such as SES, will help clinicians identify children at risk for low QoL. Such identification will help generate appropriate referrals to enhance QoL in adolescent CI users.

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.

Health-related quality of life in South African children who use cochlear implants.

Objective: To describe health-related quality of life (HRQoL) outcomes of school-going paediatric cochlear implant (CI) recipients in a South African cohort from the perspectives of parents.Design: Parents of school-going CI recipients completed the Children with Cochlear Implants: Parental Perspectives (CCIPP) CI-specific HRQoL questionnaire. The effect of different demographic variables on HRQoL outcomes was also determined.Study sample: The study sample included 54 parents of school-going (mean age = 12.2 years; SD = 3.6; range = 6.6-18.3 years) CI recipients with at least six months CI experience.Results: Children's communication and general functioning with a CI received the most positive parental ratings. Among a number of confirmed statistically significant (p < 0.05) associations between HRQoL outcomes and demographic variables, pre-lingual onset of deafness was linked to better HRQoL in terms of general functioning and well-being. While shorter duration of deafness and unilateral implantation were associated with higher parental ratings for self-reliance and well-being respectively, longer duration of CI use was linked to improved HRQoL outcomes in terms of general functioning.Conclusion: Parents assigned positive ratings to their child's HRQoL. This exploration of children's HRQoL related to their CIs contributes to evidence-based paediatric CI services that promote optimal psychosocial outcomes.