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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 26  |  Issue : 4  |  Page : 258-262

Comparison of auditory and speech outcome score with parental satisfaction after cochlear implantation in children


1 Department of ENT and Head & Neck Surgery, Tribhuvan University Teaching Hospital, MMC, IOM, Kathmandu, Nepal
2 Speech and Audiology, Tribhuvan University Teaching Hospital, MMC, IOM, Kathmandu, Nepal

Date of Submission18-Dec-2019
Date of Acceptance04-Apr-2021
Date of Web Publication23-Apr-2021

Correspondence Address:
Dr. Pabina Rayamajhi
Department of ENT and Head and Neck Studies, IOM, Tribhuvan University Teaching Hospital, MMC, Kathmandu
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_137_19

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  Abstract 


Introduction: The result of cochlear implantation is commonly assessed postoperatively by scores such as Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores. Since parents are the main people involved in the day-to-day life of children, parental satisfaction also counts for the assessment of the child's progress after implantation. The objective of the study is to compare the auditory and speech outcome score with parental satisfaction after cochlear implantation in children. Methods: The auditory performance was assessed by the CAP score and the speech by the SIR score. The parents were asked for their satisfaction in their children's audiological and speech progress after surgery by questionnaire. The two results were compared to see the difference in the rating scales and the parents' satisfaction. Results: The CAP score reached a maximum of 7 in children implanted before 3 years of age and reached a maximum of 6 in children implanted after 3 years of age. The SIR score reached the highest of 5 in children before 3 years of age and a maximum of 3 in children implanted after 3 years of age. The parental score of satisfaction was also better in children implanted before 3 years of age and correlated with the CAP and SIR score results. Conclusion: The CAP and SIR scores were better in children implanted at an earlier age. The CAP and SIR scores were comparable with parental satisfaction after 1 year of auditory and speech habilitation.

Keywords: Categories of Auditory Performance score, cochlear implantation, habilitation, Speech Intelligibility Rating score


How to cite this article:
Rayamajhi P, Adhikary AK, Shrestha S, Thapa NM, Neupane S. Comparison of auditory and speech outcome score with parental satisfaction after cochlear implantation in children. Indian J Otol 2020;26:258-62

How to cite this URL:
Rayamajhi P, Adhikary AK, Shrestha S, Thapa NM, Neupane S. Comparison of auditory and speech outcome score with parental satisfaction after cochlear implantation in children. Indian J Otol [serial online] 2020 [cited 2021 Oct 23];26:258-62. Available from: https://www.indianjotol.org/text.asp?2020/26/4/258/314337




  Introduction Top


Cochlear implantation is increasingly being performed day by day with its expanding indications. Yet, it is still mostly done in children with congenital bilateral profound sensorineural hearing loss. The earlier the diagnosis and intervention in these children, the better is the speech outcome in them.[1],[2] The result of cochlear implantation in these children depends on many factors such as the age of implantation, associated comorbidities, inner ear structural development, family, and social environment.

The success of a cochlear implantation is based not only on the surgical outcomes but also on the audiological and speech improvement in the patients postoperatively. The ultimate goal after cochlear implantation in prelingual pediatric patients is good hearing and speech.[3] There are various tools to assess the postcochlear implantation habilitation results, and the one followed in our study is the Categories of Auditory Performance (CAP)[4] scores and Speech Intelligibility Rating (SIR)[5] by O'Donoghue et al. The score is a hierarchical score, easily recordable, and can be done on a regular interval to see the progress of the patients as well.

After any surgical intervention, parents are the most important critics of their child's well-being.[6] They are more aware of their child's daily activities and their day-to-day progress after surgical interventions. Besides, in the long rehabilitation period after cochlear implantation, parents' continuous involvement is vital and very important in the child's auditory and speech progress, use, and maintenance of the device also.[7]

In this study, we have assessed the CAP and SIR scores then compared with parental satisfaction after 1 year of cochlear implantation. The aim of the study was to correlate the auditory and speech scores with parental satisfaction of their child's progress.


  Methods Top


This retrospective study was done in pediatric prelingual patients who had undergone cochlear implantation surgery in the Department of ENT and Head and Neck Surgery, TU Teaching Hospital. All the prelingual pediatric cochlear implant surgeries done with complete data of 1 year of habilitation scores from June 2012 to May 2019 were included and analyzed for the present study. The CAP and SIR scores after at least 1 year of surgery were analyzed. The children with comorbidities and syndromes and revision cases were excluded from the study. The patients' auditory outcomes were assessed using the CAP score as described by O'Donoghue et al., as shown in [Table 1]. The SIR score by O'Donoghue et al. was used to measure the outcome of cochlear implantation with respect to speech, as shown in [Table 2].
Table 1: Categories of Auditory Performance score (O'donoghue et al., 1999)

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Table 2: Speech intelligibility ratio score (O'donoghue et al., 1999)

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Simultaneously, the parents of the same children were asked about their satisfaction on their child's progress. The record would be kept as highly satisfied, moderately satisfied, and unsatisfied. The CAP and SIR score rating is then correlated with the parents' satisfaction.

The CAP and SIR scores of all the patients were tabulated in Excel datasheet and analyzed according to the age of the patients at the time of implantation. Statistical test Fisher's exact test was applied, and P < 0.05 was considered as a significant difference.


  Results Top


A total of forty-seven prelingual pediatric patients with complete data of their CAP and SIR scores with parents' available response were analyzed.

Out of the total patients, 66% of the patients were males and the remaining 34% were females making male-to-female ratio as 1.9:1. The gender distribution is shown in [Figure 1], with males showing the predominance.
Figure 1: Gender distribution of the patients (n = 47)

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Only the patients 6 years and below at the time of cochlear implantation were included in the study. The age distribution is shown in [Figure 2].
Figure 2: Age distribution (n = 47)

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The auditory-verbal therapy (AVT) scores after 1 year was recorded in all the patients. The CAP and SIR score results of the patients were tabulated and analyzed.

In children implanted at 1–3 years of age, the CAP score ranged from 4 to 7 and the SIR score ranged from 3 to 5 after 1 year of AVT. In children implanted at 4–6 years of age, the CAP score ranged from 3 to 6 and the SIR score ranged from 2 to 3 at the end of 1 year, as shown in [Figure 3] and [Figure 4]. Thus, it is seen that the earlier the child is implanted better is their CAP and SIR scores on AVT.
Figure 3: Categories of Auditory Performance and Speech Intelligibility Rating score distribution in 1–3-year-old patients (n = 26)

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Figure 4: Categories of Auditory Performance and Speech Intelligibility Rating score distribution in 4–6-year-old patients (n = 21)

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Parental satisfaction was assessed by interviewing the parents regarding their child's improvement post-AVT after 1 year. They were interviewed, and response was kept on the scale of highly satisfied, moderately satisfied, and unsatisfied. They were shown in [Figure 5] and [Figure 6].
Figure 5: Parental satisfaction on auditory response of the child (n = 47)

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Figure 6: Parental satisfaction on speech response of the child (n = 47)

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The CAP and SIR score response was compared with parental satisfaction and analyzed as shown in [Table 3], [Table 4], [Table 5], [Table 6].
Table 3: Categories of Auditory Performance score correlation with parental satisfaction in 1-3-year-old children

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Table 4: Categories of Auditory Performance score correlation with parental satisfaction in 4-6-year-old children

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Table 5: Speech Intelligibility Rating score correlation with parental satisfaction in 1-3-year-old children

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Table 6: Speech Intelligibility Rating score correlation with parental satisfaction in 4-6-year-old children

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  Discussion Top


Cochlear implantation is the treatment for prelingual bilateral profound sensorineural hearing loss children. Sooner, the treatment better is the audiological and speech outcome. Due to the neural plasticity, the implant result is always better in the younger implanted children, preferably in before 2 years of life.[8]

The outcome of cochlear implantation is not only dependent on the surgical success and better speech processor designs but on many factors such as the age of the implantation, the associated comorbidities, the social, environmental factors, the parental involvement, and the auditory-verbal habilitation.[9] Postimplantation, the AVT usually is done for 1–2 years. Regular AVT attendance holds an important place in the outcome of the implantation, and we too followed 1 year of AVT in our institute.

There are many different tools to assess cochlear implantation. Among which, CAP and SIR score is the most common one that is followed in many centers,[10] and we too have used the scores to assess the outcome of our implantees at 1 year. The CAP and SIR scores are practical, hierarchical scale of auditory perception ability and speech performance related more to the real-life situations.[11],[12] It is used in the age range of children in the present study and can be used over an extended period of time. Many centers assess the CAP and SIR scores at regular interval which is one of the limitations in our study as we have assessed at only 1 year of habilitation.

In the present study, children were divided into two groups to assess the difference in the results of early and late implantation. Many literatures have highlighted the importance of early implantation for better outcome results in both audiological and speech aspects. Our study too shows a similar result while comparing the CAP and SIR scores at the end of 1 year in the younger children. Our study also showed that parental satisfaction was better in the children implanted before 3 years of age.

Paul et al.[13] and Schauwers et al.[14] in their studies showed a high CAP score of 5, 6, or 7 in younger implanted children. This is comparable to the findings in our study too. Dettman et al.[15] in their multicentric study of 403 children have stressed the need for early implantation hearing, better speech perception, and also for the better development of the language at long-term follow-up postimplantation. Their study includes longer follow-up with very high number of patients as compared to less sample size in our study. Thawin et al.[16] in their study had long-term follow-up till 18 months. They showed a gradual improvement in the CAP and SIR scores in their follow-up of patients over time. This highlights the need and importance of long-term follow-up to actually assess the result of cochlear implantation.

Apart from the CAP and SIR scores which monitor the child's improvement, parental satisfaction is an important factor in determining the success. Parents are involved in a daily basis in the child's habilitation and can judge their children's progress both in the hospital and home as well.

Huttunen et al.[8] in their study of parental satisfaction in postcochlear implantation of Finnish children of 3–15 years showed great satisfaction with the quality of life of their children. Compared to our study, they had taken not only the audiological and speech improvement but also the social relations, improved communication, and self-reliance as well. In their study, better communication and self-reliance among parents was also observed after cochlear implantation in children.

Zaidman-Zait and Most[17] stressed the importance of taking into account the goals and aspiration of the parents in cochlear implantation. Cheng and Niparko[18] stressed the parental views on language development, social adjustments, and school achievements after cochlear implantation. They had highlighted the importance of taking the parental views on the above matters to guide the rehabilitation process of the cochlear implantee children. Various studies[19],[20] have undertaken different types of questionnaire methods and open- or closed-set formats to interview parents for the satisfaction after implantation. Few authors[21],[22] have explored the parental expectations, satisfaction on implant habilitation, and quality of life. The authors have further highlighted the difference in the format of the questionnaires depending on the social and cultural differences of the country.

We too have included parental satisfaction in a questionnaire basis to assess the postimplantation habilitation in children. The children implanted at 3 years and below showed highly satisfactory parental response showing the importance of early implantation. Our study compared the CAP and SIR scores with parental satisfaction which correlated with similar results. The highly satisfied parents were from the younger age group with the CAP score of 5, 6, or 7 at the end of 1 year and the SIR score of 4 and 5. The unsatisfied group of parents was mainly in the older children and with the poorer CAP and SIR scores. Thus, it is seen that the CAP and SIR scores correlated well with parental satisfaction.


  Conclusion Top


The CAP and SIR scores correlated well with parental satisfaction after 1 year of habilitation. The highly satisfied parents with the CAP score of 6 and 7 and the SIR score of 4 and 5 were more in the children implanted before 3 years of age with high significance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
O'Donoghue GM, Nikolopoulos TP, Archbold SM, Tait M. Speech perception in children after cochlear implantation. Am J Otol 1998;19:762-7.  Back to cited text no. 1
    
2.
Waltzman SB, Cohen NL, Gomolin RH, Green JE, Shapiro WH, Hoffman RA, et al. Open-set speech perception in congenitally deaf children using cochlear implants. Am J Otol 1997;18:342-9.  Back to cited text no. 2
    
3.
Ganek H, McConkey Robbins A, Niparko JK. Language outcomes after cochlear implantation. Otolaryngol Clin North Am 2012;45:173-85.  Back to cited text no. 3
    
4.
Nikolopoulos TP, Archbold SM, O'Donoghue GM. The development of auditory perception in children following cochlear implantation. Int J Pediatr Otorhinolaryngol 1999;49 Suppl 1:S189-91.  Back to cited text no. 4
    
5.
Allen C, Nikolopoulos TP, Dyar D, O'Donoghue GM. Reliability of a rating scale for measuring speech intelligibility after pediatric cochlear implantation. Otol Neurotol 2001;22:631-3.  Back to cited text no. 5
    
6.
Nikolopoulos TP, Lloyd H, Archbold S, O'Donoghue GM. Pediatric cochlear implantation: The parents' perspective. Arch Otolaryngol Head Neck Surg 2001;127:363-7.  Back to cited text no. 6
    
7.
Incesulu A, Vural M, Erkam U. Children with cochlear implants: Parental perspective. Otol Neurotol 2003;24:605-11.  Back to cited text no. 7
    
8.
Huttunen K, Rimmanen S, Vikman S, Virokannas N, Sorri M, Archbold S, et al. Parents' views on the quality of life of their children 2-3 years after cochlear implantation. Int J Pediatr Otorhinolaryngol 2009;73:1786-94.  Back to cited text no. 8
    
9.
Kameswaran M, Raghunandhan S, Natarajan K, Basheeth N. Indian journal clinical audit of outcomes in cochlear implantation an Indian experience. Otolaryngol Head Neck Surg 2006;58:69-73.  Back to cited text no. 9
    
10.
Beadle EA, McKinley DJ, Nikolopoulos TP, Brough J, O'Donoghue GM, Archbold SM. Long-term functional outcomes and academic-occupational status in implanted children after 10 to 14 years of cochlear implant use. Otol Neurotol 2005;26:1152-60.  Back to cited text no. 10
    
11.
Hassanzadeh S. Outcomes of cochlear implantation in deaf children of deaf parents: Comparative study. J Laryngol Otol 2012;126:989-94.  Back to cited text no. 11
    
12.
Nikolopoulos TP, Archbold SM, Gregory S. Young deaf children with hearing aids or cochlear implants: Early assessment package for monitoring progress. Int J Pediatr Otorhinolaryngol 2005;69:175-86.  Back to cited text no. 12
    
13.
Paul JG, Carina DB, Kristin D, de Ceulaer G, Yperman M, Somers T, et al. Outcomes of cochlear implantation at different ages from 0 to 6 years. Otology Neurotol 2002;23:885-90.  Back to cited text no. 13
    
14.
Schauwers K, Gillis S, Daemers K, de Beukelaer C, Govaerts PJ. Cochlear implantation between 5 and 20 months of age: The onset of babbling and the audiologic outcome. Otol Neurotol 2004;25:263-70.  Back to cited text no. 14
    
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Dettman SJ, Dowell RC, Choo D, Arnott W, Abrahams Y, Davis A, et al. Long-term communication outcomes for children receiving cochlear implants younger than 12 months: A multicenter study. Otol Neurotol 2016;37:e82-95.  Back to cited text no. 15
    
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Thawin C, Kanchanalarp C, Lertsukprasert K, Cheewaruangroj W, Khantapasuantara K, Ruencharoen S. Auditory performance of cochlear implant children aged 2-5 years. J Med Assoc Thai 2006;89:1923-7.  Back to cited text no. 16
    
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Zaidman-Zait A, Most T. Cochlear implants in children with hearing loss: Maternal expectations and impact on the family. Volta Rev 2005;105:129-50.  Back to cited text no. 17
    
18.
Cheng AK, Niparko JK. Cost-effectiveness of the cochlear implant in children. In: Cochlear Implantation: Cost Creating or Cost Saving? Proceedings of Conference on Health Technology Assessment, Queen's Medical Centre, Nottingham, UK, 18 May 2001. Oxford, UK: Hughes Associates; 2001. p. 111-9.  Back to cited text no. 18
    
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Li Y, Bain L, Steinberg AG. Parental decision-making in considering in considering cochlear implant technology for a deaf child. Int J Pediatric Otorhinolaryngol 2004;68:1027-38.  Back to cited text no. 19
    
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Okubo S, Takahashi M, Kai I. How Japanese parents of deaf children arrive at decisions regarding pediatric cochlear implantation surgery: A qualitative study. Soc Sci Med 2008;66:2436-47.  Back to cited text no. 20
    
21.
Archbold R, Sach C, O'Neill C, Lutman M, Gregory S. Outcomes from cochlear implantation for child and family: Parental perspective. Deaf Educ Int 2008;10:120-42.   Back to cited text no. 21
    
22.
Beadle EA, Shores A, Wood EJ. Parental perceptions of the impact upon the family of cochlear implantation in children. Ann Otol Rhinol Laryngol Suppl 2000;185:111-4.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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