Hearing-Impaired Children in the United Kingdom, I: Auditory Performance, Communication Skills, Educational Achievements, Quality of Life, and Cochlear Implantation

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Abstract
Objectives: The objectives of this study were to identify variables that are associated with differences in outcome among hearing-impaired children and to control those variables while assessing the impact of cochlear implantation. Study Design: In a cross-sectional study, the parents and teachers of a representative sample of hearing-impaired children were invited to complete questionnaires about children’s auditory performance, spoken communication skills, educational achievements, and quality of life. Multiple regression was used to measure the strength of association between these outcomes and variables related to the child (average hearing level, age at onset of hearing impairment, age, gender, number of additional disabilities), the family (parental occupational skill level, ethnicity, and parental hearing status), and cochlear implantation. Results: Questionnaires were returned by the parents of 2858 children, 468 of whom had received a cochlear implant, and by the teachers of 2241 children, 383 of whom had received an implant. Across all domains, reported outcomes were better for children with fewer disabilities in addition to impaired hearing. Across most domains, reported outcomes were better for children who were older, female, with a more favorable average hearing level, with a higher parental occupational skill level, and with an onset of hearing-impairment after 3 years. When these variables were controlled, cochlear implantation was consistently associated with advantages in auditory performance and spoken communication skills, but less consistently associated with advantages in educational achievements and quality of life. Significant associations were found most commonly for children who were younger than 5 years when implanted, and had used implants for more than 4 years. These children, whose mean (preoperative, unaided) average hearing level was 118 dB, were reported to perform at the same level as nonimplanted children with average hearing levels in the range from 80 dB to 104 dB, depending on the outcome measure. Conclusions: When rigorous statistical control is exercised in comparing implanted and nonimplanted children, pediatric cochlear implantation is associated with reported improvements both in spoken communication skills and in some aspects of educational achievements and quality of life, provided that children receive implants before 5 years of age.