Dev Apurva Nidgundi, Nahas Gabriel, Pappas Alyson, Ambrose Tracey, Craun Patricia, Fustos Emily, Reilly Brian K, Preciado Diego
Division of Pediatric Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
Division of Hearing and Speech, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20310, United States.
Int J Pediatr Otorhinolaryngol. 2022 Jun;157:111119. doi: 10.1016/j.ijporl.2022.111119. Epub 2022 Mar 26.
Research has suggested that early cochlear implantation is associated with improved language outcomes. Select studies demonstrate that this translates into a higher quality of life following implantation. Previous work from our group has shown that underinsurance represents a risk factor for worsened auditory and language outcomes for implantees. However, to our knowledge, the effect of insurance status on quality of life outcomes following cochlear implantation has not been evaluated.
To assess quality of life outcomes for children receiving cochlear implants, accounting for age at implantation, insurance status, gender, surgeon, number of implants and duration of follow-up since implantation.
A retrospective study using the Glasgow Children's Benefit Inventory (GCBI), a validated questionnaire measuring quality of life across four domains: learning, emotion, vitality and physical heath. Multivariate linear regression was used to examine the effects of age at implantation, insurance status, number of implants, sex, surgeon, and duration of follow-up on GCBI scores. Age at implantation was assessed as both a continuous and dichotomous variable, comparing children implanted by 12 months of age with those implanted after 12 months.
Children's National Health System in Washington, DC, a tertiary academic referral center.
The GCBI was administered telephonically to parents/guardians of prelingually deaf children aged 2-16 years who received cochlear implants at the center between January 1, 2008 and December 31, 2018.
Of 169 prelingually deafened implantee children who met inclusion criteria, parents/guardians of 64 (37.9%) responded to the questionnaire. After excluding children with late implantation (≥7 years age at CI) and missing GCBI responses, the final analytic sample consisted of 57 children. The mean age (SD) of the children at the time of the study was 3.3 (1.9) years, 63.2% were publicly insured, and 73.7% were implanted after 12 months of age. Average duration of follow-up was 3.9 (2.8) years. On a scale of -100 to +100, GCBI scores ranged from 41.7 to 95.8 (mean (SD), 64.0 (10.3)). Public health insurance (β, -5.8 [95% CI, -10.6 to -0.01]), and older age at the time of implantation (β, -0.1 [95% CI, -0.3 to 0.0]), particularly implantation following 12 months of age (p < 0.05), were significantly associated with lower GCBI scores after implantation.
Publicly insured recipients of cochlear implants and children implanted at an older age, particularly after 12 months of age, experienced significantly lower quality of life measures.
研究表明，早期人工耳蜗植入与改善语言结果相关。部分研究表明，这转化为植入后更高的生活质量。我们团队之前的研究表明，保险不足是植入者听觉和语言结果恶化的一个风险因素。然而，据我们所知，保险状况对人工耳蜗植入后生活质量结果的影响尚未得到评估。
评估接受人工耳蜗植入儿童的生活质量结果，同时考虑植入时的年龄、保险状况、性别、外科医生、植入数量以及植入后的随访时间。
一项回顾性研究，使用格拉斯哥儿童福利量表（GCBI），这是一份经过验证的问卷，用于测量四个领域的生活质量：学习、情绪、活力和身体健康。多变量线性回归用于检验植入时年龄、保险状况、植入数量、性别、外科医生以及随访时间对GCBI评分的影响。植入时年龄被评估为连续变量和二分变量，将12个月龄前植入的儿童与12个月龄后植入的儿童进行比较。
华盛顿特区的儿童国家卫生系统，一家三级学术转诊中心。
通过电话向2008年1月1日至2018年12月31日期间在该中心接受人工耳蜗植入的2至16岁语前聋儿童的父母/监护人发放GCBI问卷。
在169名符合纳入标准的语前聋植入儿童中，64名（37.9%）的父母/监护人回复了问卷。在排除植入较晚（人工耳蜗植入时年龄≥7岁）和GCBI问卷未回复的儿童后，最终分析样本包括57名儿童。研究时儿童的平均年龄（标准差）为3.3（1.9）岁，63.2%有公共保险，73.7%在12个月龄后植入。平均随访时间为3.9（2.8）年。在-100至+100的量表上，GCBI评分范围为41.7至95.8（平均值（标准差），64.0（10.3））。公共医疗保险（β，-5.8[95%置信区间，-10.6至-0.01]）以及植入时年龄较大（β，-0.1[95%置信区间，-0.3至0.0]），特别是12个月龄后植入（p<0.05），与植入后较低的GCBI评分显著相关。
接受公共保险的人工耳蜗植入者以及年龄较大时植入的儿童，特别是12个月龄后植入的儿童，生活质量指标显著较低。
