Glaubitz Cynthia, Liebscher Tim, Hoppe Ulrich
Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, ENT-clinic, Department of Audiology and Cochlear Implant Centre, Waldstr.1, 91054, Erlangen, Germany.
Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, ENT-clinic, Department of Audiology and Cochlear Implant Centre, Waldstr.1, 91054, Erlangen, Germany.
Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111301. doi: 10.1016/j.ijporl.2022.111301. Epub 2022 Sep 6.
Although the prevalence of additional disabilities (AD) in children with a cochlear implant (CI) is high, children with such disabilities are often excluded from clinical studies, or their specific characteristics are only partially included. The literature shows that several factors need to be considered in evaluating auditory and language development in CI children with AD, including demographic variables as well as the severity and type of disability. Current findings on device use in children show correlations with auditory and language outcome, but little is known about device use specifically in children with AD. The purpose of this study was to determine the auditory and language outcome of CI children with AD and to analyse their datalogging-based daily device use, both 1 year and 2 years after implantation. In addition, any potential correlations between outcome and device use were to be identified.
A cohort of 32 CI children with 5 different types of AD were included in this retrospective analysis. The children's auditory and language outcome was assessed by the parental questionnaires LittlEARS and ELFRA and by the professional observation tool CAP (Categories of Auditory Performance) 1 and 2 years after implantation. Longitudinal device use was analysed by using the CI system-integrated data-logging; daily duration of CI use, number of coil disconnections and exposure to different listening scenes were recorded.
Overall, the cohort's auditory and language performance showed significant progress over time, while reduced abilities became more obvious after 2 years of CI experience. The mean daily duration of CI use increased significantly from 7.8 ± 2.8 to 8.2 ± 2.7 h after 2 years. High numbers of daily coil disconnections were detected, with a significant mean decrease from 83.4 ± 73.1 to 66.3 ± 54.6 whereas the percentage exposure to different listening environments was widely stable over time. Significant rank correlations were identified between outcomes measured by ELFRA and CAP with daily duration of CI use, numbers of coil disconnections and percentage of exposure to speech-characterised listening scenes.
The auditory and language outcome in CI children with AD is variable, but it progresses over time. Children benefit from a consistent daily device use as well as from a high exposure to speech-characterised environments. Device use should be monitored constantly, with particular focus on daily duration of CI use and, in particular, on the number of coil disconnections if children have a severe motor impairment. Objective data-logging is an important addition to outcome assessment by testing, observations and parental questionnaires. Although assessment in children with AD is a major challenge for professionals, comprehensive assessment is needed to improve cochlear implant services with special adaption to children with AD, and this should include audiological, development-related and psychosocial information. A unified system to classify types of disabilities could help to improve procedures for analysing different outcomes.
尽管人工耳蜗植入（CI）儿童中合并其他残疾（AD）的患病率很高，但这类残疾儿童往往被排除在临床研究之外，或者其特定特征仅被部分纳入。文献表明，在评估患有AD的CI儿童的听觉和语言发育时需要考虑几个因素，包括人口统计学变量以及残疾的严重程度和类型。目前关于儿童使用设备的研究结果显示与听觉和语言结果存在相关性，但对于患有AD的儿童具体的设备使用情况知之甚少。本研究的目的是确定患有AD的CI儿童的听觉和语言结果，并分析植入后1年和2年基于数据记录的每日设备使用情况。此外，还要确定结果与设备使用之间的任何潜在相关性。
本回顾性分析纳入了32名患有5种不同类型AD的CI儿童。在植入后1年和2年，通过家长问卷LittlEARS和ELFRA以及专业观察工具CAP（听觉表现类别）评估儿童的听觉和语言结果。通过使用CI系统集成的数据记录来分析纵向设备使用情况；记录CI的每日使用时长、线圈断开连接的次数以及接触不同聆听场景的情况。
总体而言，该队列的听觉和语言表现随时间有显著进步，而在CI使用2年后，能力下降变得更加明显。2年后，CI的平均每日使用时长从7.8±2.8小时显著增加到8.2±2.7小时。检测到每日线圈断开连接的次数较多，平均次数从83.4±73.1显著下降到66.3±54.6，而随着时间推移，接触不同聆听环境的百分比基本稳定。ELFRA和CAP测量的结果与CI的每日使用时长、线圈断开连接的次数以及接触以语音为特征的聆听场景的百分比之间存在显著的等级相关性。
患有AD的CI儿童的听觉和语言结果存在差异，但会随时间推移而进步。儿童受益于持续的每日设备使用以及高比例接触以语音为特征的环境。应持续监测设备使用情况，尤其要关注CI的每日使用时长，特别是当儿童有严重运动障碍时，要特别关注线圈断开连接的次数。客观的数据记录是对通过测试、观察和家长问卷进行的结果评估的重要补充。尽管对患有AD的儿童进行评估对专业人员来说是一项重大挑战，但仍需要进行全面评估，以改善人工耳蜗植入服务，特别针对患有AD的儿童进行特殊调整，这应包括听力学、发育相关和心理社会信息。一个统一的残疾类型分类系统有助于改进分析不同结果的程序。
