Hearing-Impaired Children in the United Kingdom, I: Auditory Performance, Communication Skills, Educational Achievements, Quality of Life, and Cochlear Implantation

Abstract

Objectives: The objectives of this study were to identify variables which are associated with differences in outcome among hearing-impaired children, and to control those variables while assessing the impact of cochlear implantation. Study design:In a cross-sectional study, the parents and teachers of a representative sample of hearing-impaired children were invited to complete questionnaires about children's auditory performance, spoken communication skills, educational achievements, and quality of life. Multiple regression was used to measure the strength of association between these outcomes and variables related to the child (average hearing level, age at onset of hearing impairment, age, gender, number of additional disabilities), the family (parental occupational skill level, ethnicity, and parental hearing status), and cochlear implantation.Results: Questionnaires were returned by the parents of 2858 children, 468 of whom had received a cochlear implant, and by the teachers of 2241 children, 383 of whom had received an implant. Across all domains, reported outcomes were better for children with fewer disabilities in addition to impaired hearing. Across most domains, reported outcomes were better for children who were older, female, with a more favourable average hearing level, with a higher parental occupational skill level, and with an onset of hearing-impairment after 3 years. When these variables were controlled, cochlear implantation was consistently associated with advantages in auditory performance and spoken communication skills, but less consistently associated with advantages in educational achievements and quality of life.Significant associations were found most commonly for children who were younger than 5 years when implanted, and had used implants for more than 4 years. TheseHearing-impaired children in the UK, I. 2 children, whose mean (pre-operative, un-aided) average hearing level was 118 dB, performed at the same level as non-implanted children with average hearing levels in the range from 80 dB to 104 dB, depending on the outcome measure. Conclusion:When rigorous statistical control is exercised in comparing implanted and non-implanted children, paediatric cochlear implantation is associated with reported improvements both in spoken communication skills and in some aspects of educational achievements and quality of life, provided that children receive implants before 5 years of age.(342 words)

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

“…In our study only parents were asked to estimate the health utility of their child, other measures (e.g., quality of life and educational attainment) were however estimated both by parents and by teachers. Stacey et al (2006) have shown that there was broad agreement between the estimates of parents and teachers on such measures, thereby suggesting that the method of obtaining health utility estimates by parental proxy is a reliable one.…”

“…This second analysis included an interaction term between AHL and cochlear implantation (i.e., the coefficient for AHL was allowed to differ, depending on whether children were implanted or nonimplanted) (Footnote 4). Further details of this approach, and examples of its use, are provided by Stacey et al (2006) and Barton et al (2006a). Analyses were performed with the SAS system (Freund & Littell, 2000).…”

“…It is an assumption of linear regression analysis that continuous variables vary linearly with the dependent variable. Accordingly, before conducting the analysis, age and AHL were transformed to vary linearly with utility using the methods described by Stacey et al (2006) (Footnote 3). Two other continuous measures, age at onset of hearing impairment and the number of additional disabilities, had skewed distributions.…”

“…It is possible therefore that the cost-effectiveness of implantation also varies according to the characteristics of the child. We focus on three characteristics which have previously been shown to exert a positive influence on the benefit associated with implantation: a younger age at implantation (Kileny, Zwolan, & Ashbaugh, 2001;Kirk, Miyamoto, Lento, Ying, O'Neill, & Fears, 2002;Miyamoto, et al, 1993;Nikolopoulos, O'Donoghue, & Archbold, 1999;Sharma, Dorman, & Spahr, 2002;Stacey, et al, 2006;Svirsky, Teoh, & Neuburger, 2004;Tyler, et al, 1997), a greater duration of implant use Tyler, et al, 1997), and a poorer preoperative average hearing level (AHL) Tyler, et al, 1997). If the cost-effectiveness of implantation varied with any of these variables, then it could be more cost-effective to implant some groups of children than others (e.g., younger children in preference to older children, or children with less favorable AHLs in preference to children with more favorable AHLs).…”

Listening skill progress in children with cochlear implants in the first three months after implantation

“…Stacey, Fortnum, Barton and Summerfield stated that short term outcomes from cochlear implantation which emerge soon after the implantation are mainly in the domain of auditory performance which includes auditory receptive capabilities and in speech communication skills which includes the perception, production and the use of spoken language. 12 They reported the medium and long term benefits of cochlear implantation to be in the domains of functional language development, educational achievements and quality of life. Educational achievements included academic abilities like reading, writing, number concept, money concept etc and the CI user's participation and attention in education while the quality of life had been judged in terms of feelings, behaviour, well-being, sociability, etc.…”