Department of Speech, Language, and Hearing, School of Behavioral and Brain Science, The University of Texas at Dallas, Richardson, Texas, USA.
Pediatric Cochlear Implant Program, Callier Center for Communication Disorders, Dallas, Texas, USA.
Ear Hear. 2021 July/Aug;42(4):1042-1053. doi: 10.1097/AUD.0000000000000999.
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.
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).
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.
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.
患有重度听力损失的儿童可以通过人工耳蜗（CI）获得声音，但他们必须佩戴设备才能从设备的交流中受益。也就是说，在使用 CI 的儿童和青少年中，如果日常设备使用不佳，可能会导致感知和语言技能发育不良。本回顾性研究重点关注了日常 CI 使用与儿童早期的交流表现（听觉技能、言语识别、表达和接受性语言）之间的关系，其假设是，更多的日常设备使用与更好的交流结果相符。
作者对使用至少 1 个具有数据记录技术的 CI 言语处理器的 5 岁以下 CI 患者进行了临床图表回顾。参与者（n=65）的平均年龄为 3.5 岁，平均植入年龄为 1.9 岁，平均设备使用时间为 1.6 年。大约四分之一的参与者有其他残疾。从每个孩子的记录中获得日常设备使用情况（即数据记录信息）、儿童特征（例如 CI 年龄）和交流技能评估（即家长问卷、言语识别测试、标准化语言评估）。研究人员进行了相关分析，以检查交流结果与日常设备使用之间的关系，并采用组间比较和相关性分析，以确定与日常设备使用显著相关的儿童特征（p<0.05，对家族错误进行校正）。
平均而言，患有 CI 的幼儿每天使用设备 6.7 小时，其中 63%的人未达到全时使用（<8 小时/天）。每天佩戴 CI 时间较长的无其他残疾的儿童，其听觉、言语识别和语言能力显著提高。在有其他残疾的年轻 CI 用户中，每日设备使用与早期听觉技能之间也存在显著相关性，但对于该亚组，相关性更为复杂。每日设备使用时间较长与 CI 年龄较小和设备使用经验较长显著相关。在有无其他残疾、单侧与双侧设备配置、手语与口语、私人与政府资助保险方面，设备使用情况存在差异。
日常设备使用与早期交流之间的紧密关系表明，临床医生和家长应注重增加幼儿每天佩戴 CI 的时间，以提高听觉和语言能力。然而，干预策略必须考虑到持续使用设备的障碍，以及为支持难以持续使用设备的幼儿 CI 家庭的目标，以有效地支持这些家庭。
