May 2020 The Hearing Journal
It is well known that early cochlear implantation at a young age leads to better speech and language development outcomes in children with hearing loss, thanks to the large volume of dedicated research on the subject. What remains unclear is how the advantages from early implantation translate into better social and communication skills and, ultimately, improved quality of life in adolescence.
Many studies have attempted to elucidate that connection but yielded conflicting results with quite a bit of variability among their subjects with cochlear implants (CIs), said Margarita Hofmann, AuD, a clinical audiologist at McMaster Children's Hospital, which is part of Hamilton Health Services in Hamilton, Ontario, Canada. “Some studies found that quality of life [QoL] did not differ significantly between children with CIs and children with normal hearing, while other studies determined difficulties in certain aspects of QoL, including peer acceptance, social-emotional adjustment, and self-esteem relative to hearing peers,” she said. “This variability in results was attributed, in part, to various factors that have been found to impact performance with a CI, such as age at implant, mode of communication, and cognitive factors, but which were never formally researched.”
Given that the benefits of early implantation are already well documented, Hofmann and her colleagues decided to control for the age of implant to take a closer look at other factors that could affect the quality of life outcome of adolescent CI users, including socioeconomic status (SES) and communication methodology, in their research. Their study included only adolescents who received a CI prior to the age of 5, a total of 43 subjects, and excluded children who demonstrated factors known to negatively impact performance, such as cognitive, visual, or developmental delay.
Hofmann and her colleagues zeroed in on adolescents because while many studies have established that the age at implantation is a significant factor in determining the benefits that young children receive from CIs, few have followed up with their subjects to see how these young CI recipients were coping in adolescence. Another reason they wanted to study this population is that superior social competence and peer relationships in adolescents have been shown to correlate with a better quality of life. “As we know, adolescence is a challenging time for anyone, let alone someone with a disability or handicap,” Hofmann said. “We wanted to know, for example, do these individuals feel that they are bullied? Do they feel that they struggle to make friends? What is their perception of their relationship with their parents? Overall, we were interested to know if these adolescent cochlear implant users perceived that they were treated differently from their hearing peers, and how this affected their overall well-being, and what factors contributed to these outcomes.”
Hofmann and her colleagues compared the demographic information, word and sentence recognition scores, Quality of Life of Deaf or Hard-of-Hearing Youth scores, and Kidscreen-10 Index scores of adolescent CI users in the low SES group (enrolled in a Medicaid plan) and mid-high SES group (not enrolled in a Medicaid plan), and found that those in the low SES category were faced with more challenges in terms of social issues. “The group of adolescents in the lower SES group reported feeling bullied more, feeling like their hearing loss impedes their future, and that they are less likely to ask for help when needed,” Hofmann said.
Adolescent CI users in the low SES group also scored significantly poorer on measures of sentence recognition than members of the high SES group. Hofmann and her colleagues hypothesised that the differences may be attributed to a lower level of parental education, poor follow-up patterns, an impoverished language environment, and reduced linguistic exposure, all of which may lead to reduced outcomes with a CI.
Despite these negative outcomes, adolescent CI users in the study rated their overall health and well-being significantly greater than those of their normal-hearing peers, based on a comparison of the mean score obtained for the study participants and the normative data provided by the Kidscreen manual. “Again, the adolescents included in our study were implanted before the age of 5 and the results of our study reflect a select sample of adolescents with CI,” Hofmann said. “Nonetheless, this was an encouraging finding and warrants further research.”
Knowledge of the factors that influence overall language skills and perceived QoL in adolescents with a CI is of practical importance for parents and caregivers, for clinicians, and for formulating plans of early intervention and appropriate support, Hofmann said. “The examination of communication outcomes, along with other factors that influence QoL, such as SES and communication methodology, will help clinicians identify children at risk for low QoL,” she said. “Such identification will help generate appropriate referrals to enhance QoL and optimise long-term language growth in adolescent CI users.”