Scottish Cochlear Implant Programme, Crosshouse Hospital, Kilmarnock Road, Kilmarnock, Scotland, KA2 0BE, UK.
Scottish Cochlear Implant Programme, Crosshouse Hospital, Kilmarnock Road, Kilmarnock, Scotland, KA2 0BE, UK.
Int J Pediatr Otorhinolaryngol. 2020 Sep;136:110223. doi: 10.1016/j.ijporl.2020.110223. Epub 2020 Jul 11.
An estimated 30-40% of children undergoing cochlear implantation (CI) have additional disabilities and traditional outcome measures are often not reliable or appropriate. Few studies have evaluated long-term quality of life (Qol) in this group. Our aim was to assess long term QoL of children implanted with complex needs against a cohort of children implanted without. We also compared both groups for secondary outcome measures such as parental opinion, complications and hours of device wear.
A retrospective casenote review of all children undergoing assessment between 2005 and 2010 was undertaken. Children with complex needs were identified using the Scottish Complex Needs Group Criteria (ISD 2006). Quality of life was measured using the GCBI (Glasgow Children's Benefit Inventory) which is a validated questionnaire suitable for the retrospective assessment of health-related QoL following paediatric surgical interventions. It consists of a 200-point scale which ranges from -100 (maximal harm) to +100 (maximal benefit) and can be analysed in four QoL subdomains (health, vitality, physical, learning). Parents were also asked to complete a simple questionnaire asking if they would recommend CI to other families and whether they would wish their child to undergo CI if given the option again.
174 children were implanted and 17 (10%) were found to have complex needs. Follow-up ranged from 4 to 9 years. Total GCBI scores were similarly high between groups but significantly higher scores were found in the emotion (p = 0.05) and learning domains (p = 0.03) in the complex needs group. Linear regression analysis was used to show that total GCBI score was not influenced by the number of categories of impairment (R = 0.0123) in the complex needs group. All parents of children with complex needs said that they would proceed with implantation again or recommend to a friend. The complication rate in the complex needs group was higher (29 vs 15%), with device failure being particularly more common. Data-logging was consistent between both groups. A higher rate of development of significant other health issues that could affect outcome was found in the complex needs group (35% vs 8%).
Our study suggests that children with complex needs have comparable long-term QoL scores to those without and seem to particularly benefit in the domains of learning and emotion. Complications are higher in this group and there remains an increased risk of further development of medical conditions following early implantation, which may influence progress.
据估计，30-40%接受耳蜗植入（CI）的儿童存在其他残疾，传统的结果衡量标准往往不可靠或不适用。很少有研究评估这组儿童的长期生活质量（Qol）。我们的目的是评估具有复杂需求的儿童与没有这些需求的儿童的长期 QoL。我们还比较了两组儿童的次要结果测量指标，如父母意见、并发症和设备佩戴时间。
对 2005 年至 2010 年间接受评估的所有儿童进行回顾性病例记录审查。使用苏格兰复杂需求小组标准（ISD 2006）确定具有复杂需求的儿童。生活质量使用 GCBI（格拉斯哥儿童受益量表）进行测量，这是一种适合于回顾性评估儿童手术干预后与健康相关的 QoL 的验证问卷。它由 200 分制组成，范围从-100（最大伤害）到+100（最大获益），可以在四个 QoL 子领域（健康、活力、身体、学习）进行分析。父母还被要求完成一份简单的问卷，询问他们是否会向其他家庭推荐 CI，如果有机会再次选择，他们是否希望自己的孩子接受 CI。
共植入 174 例儿童，其中 17 例（10%）被发现有复杂需求。随访时间为 4 至 9 年。两组之间的总 GCBI 评分相似，但在复杂需求组中，情绪（p=0.05）和学习领域（p=0.03）的评分显著更高。线性回归分析表明，复杂需求组中，GCBI 总分不受损伤类别的数量（R=0.0123）的影响。复杂需求组所有儿童的父母均表示，如果有机会再次选择，他们将再次进行植入或推荐给朋友。复杂需求组的并发症发生率更高（29%比 15%），设备故障尤其更为常见。两组之间的数据记录一致。复杂需求组发现存在更多可能影响结果的其他健康问题（35%比 8%）。
我们的研究表明，具有复杂需求的儿童具有可比的长期 QoL 评分，且似乎在学习和情绪领域特别受益。该组并发症发生率较高，且早期植入后进一步发展医疗状况的风险增加，这可能会影响进展。
