Relationships Between Daily Device Use and Early Communication Outcomes in Young Children With Cochlear Implants

Abstract

Objectives: Children with significant hearing loss can gain access to sound via a cochlear implant (CI), but they must wear the device to reap the communication benefits of the device. That is, poor daily device use may result in underdeveloped perceptual and language skills in children and adolescents using CIs. This retrospective study focuses on the relationship between daily CI use and communication performance (auditory skills, speech recognition, expressive and receptive language) in young children, with the hypothesis that greater daily device use coincides with better communication outcomes. Design: The authors conducted a clinical chart review of patients with CIs younger than 5 years old who used at least 1 CI speech processor with datalogging technology. Participants (n = 65) had a mean chronologic age of 3.5 years, mean implantation age of 1.9 years, and mean device experience of 1.6 years. Approximately one quarter of participants had additional disabilities. Daily device use (i.e., datalogging information), child characteristics (e.g., age at CI), and assessments of communication skills (i.e., parent questionnaires, speech recognition tests, standardized language assessments) were obtained from each child’s records. The investigators performed correlational analyses to examine relationships between communication outcomes and daily device use, and they employed group comparisons and correlations to identify child characteristics that were significantly associated with daily device use (p < 0.05, corrections for family-wise error). Results: Young children with CIs used their device, on average, 6.7 hr/d, with 63% below full-time use (<8 hr/d). Children without additional disabilities who wore their CI more hours per day had significantly better auditory, speech recognition, and language skills. A significant correlation also emerged between daily device use and early auditory skills in young CI users with additional disabilities, though relationships were more complicated for this subsample. Longer daily device use significantly correlated with younger age at CI and longer device experience. Differences in device use occurred in regards to absence versus presence of additional disabilities, bilateral versus unilateral device configuration, sign versus spoken language, and private versus government-assisted insurance. Conclusions: The strong relationship between daily device use and early communication suggests clinicians and parents should focus on increasing the number of hours per day young children wear their CIs to enhance auditory and language outcomes. However, intervention strategies must consider barriers to consistent device use and goals of the family to efficiently and effectively support families of young children with CIs who struggle with inconsistent device use.

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

“…Wiseman, on the other hand, reported a strong relationship between daily device use and early communication. The authors suggested that intervention strategies must also consider barriers to consistent device use and insisted on support for young children with CIs who struggle with inconsistent device use [ 27 ]. Karltorp et al investigated children implanted between 5 and 11 months of age and showed an age-equivalent level of language understanding and improved vocabulary outcomes, which was earlier than when compared to children implanted between 12 and 29 months [ 38 ].…”

“…The literature suggests that significantly poorer device use is accompanied with demographic factors such as younger chronologic age, lower maternal education, presence of additional disability, and even sign-focused communication mode, etc. [ 27 , 31 , 51 ]. The authors investigated factors in addition to older age at implantation, such as satisfaction with the external component in analyzing the BTE and SU processors.…”

“…Numerous studies have identified a link between daily device use and communication outcomes in pediatric CI users [ 27 ]. Several studies in pediatric CI users reported the positive correlation of daily device use with speech recognition skills, and expressive and receptive language [ 28 , 29 , 30 , 31 ].…”

“…As a further consequence, one could also assume that frequent device use goes hand in hand with high device satisfaction. Currently, most studies concerning pediatric CI users have focused on assessing auditory skills and speech including verbal language ability or communication skills but never linked outcomes with quantitative device satisfaction and possibly related device use as well as device type dependency [ 4 , 8 , 13 , 27 , 31 , 32 , 33 , 34 ].…”

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

“…Audiometric and medical criteria provide guidance for when to discuss pediatric implantation, but the CI team also should take a holistic approach considering the family’s lifestyle, goals, and expectations for the child (Moeller 2000; Moeller et al 2013; Dettman et al 2016b). Nonaudiologic factors such as the child and family’s quality of life, availability of resources, history of family involvement, assurance of consistent device use during all waking hours, and realistic expectations afford a well-rounded perspective of a child’s prognosis for CI outcomes (Moeller 2000; Nikolopoulos et al 2004; O’Brien et al 2010; Park et al 2019a; Wiseman et al 2021).…”