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.

Objective To identify characteristics associated with inability to progress to open-set speech recognition in children who are 5 years post cochlear implantation. Study Design Prospective, longitudinal and multidimensional assessment of auditory development over 5 years. Setting Six tertiary cochlear implant (CI) referral centers in the US. Patients Children with severe-to-profound hearing loss who underwent implantation before age 5 years enrolled in the Childhood Development after Cochlear Implant (CDaCI) study, categorized by level of speech recognition ability. Intervention(s) Cochlear implantation prior to 5 years of age and annual assessment of emergent speech recognition skills. Main outcome measure(s) Progression to open-set speech recognition by 5 years after implantation. Results Less functional hearing prior to implantation, older age at onset of amplification, lower maternal sensitivity to communication needs, minority status, and complicated perinatal history were associated with inability to obtain open set speech recognition by 5 years. Conclusions Characteristics of a subpopulation of children with CIs that were associated with an inability to achieve open-set speech recognition after 5 years of CI experience were investigated. These data distinguish pediatric CI recipients at risk for poor auditory development and highlight areas for future interventions to enhance support of early implantation.

OBJECTIVE To assess children’s health-related quality of life (HRQL) and development after cochlear implant (CI) surgery, and compare improvements between different age of implantation categories. STUDY DESIGN Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls. SETTING Six US CI centers. PATIENTS Deaf children who received CI (n=188) and hearing children of comparable ages (n=97). INTERVENTION CI before 5 years of age. MAIN OUTCOME MEASURE Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children’s growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning. RESULTS Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by four years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after four years. Cognition and speech recognition were positively associated with both HRQL and development. CONCLUSIONS Parental perspectives on quality of their child’s life and development provide practical insight into the optimal timing of interventions for early onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

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