A Predictive Model of Hearing Outcome for Cochlear Implantation in Children below 5 Years of Age
Background: Cochlear Implantation (CI) has become an important modality of treatment for children with severe to profound pre-lingual sensorineural hearing loss who do not benefit from hearing aids (HAs). The final outcome is not totally predictable, as there are a large number of factors which either alone or in combination will play their roles in the final outcome of CI.
Aim of the Study: This study aims to evaluate prospectively the relative impact of multiple pre-, peri-, and post-operative factors on the final outcome of the CI in pre-lingual hearing impaired children aged 5 years under “Sruthitharangam” free cochlear implant program of Government of Kerala.
Materials and Methods: This study was conducted at Government Medical College, Kozhikode (GMC-KKD), Kerala, from January 2014 to January 2015. The study group consisted of 60 patients screened from the patients who have attended Auditory verbal habilitation (AVH) categories of Auditory Performance (CAP) test, Meaningful auditory integration scale (MAIS) and Speech intelligibility rating test (SIR) at GMC-KKD, Kerala. Counseling of parents was done regarding regular follow-ups and therapy/support to the child at home.
Observations and Results: Pearson correlation test and Spearman correlation test were done to check the correlation between age at which HA was first fitted and MAIS scores. Correlation between the age at which HA first fitted and MAIS was negative. As the age at which HAs were fitted increases, the MAIS score decreases. This indicates the significance of using the residual hearing and stimulation of auditory nerve as early as possible. Pearson correlation and Spearman correlation tests were applied to check the correlation between age of surgery and MAIS score and found that there was negative correlation existing between age of surgery and MAIS scores. This meant, as the age at which surgery was done increases, the MAIS score decreases. Pearson correlation test and Spearman correlation tests were applied to check the MAIS scores and duration of AVH with HAs.
Conclusions: A Cochlear implant was not a passive sensory aid or sensory substitution device that simply replaces a damaged or defective cochlea to restore normal hearing but requires prolonged period of aural rehabilitation that involves perceptual learning, adaptation, and readjustment of their attention. The various risk factors that affect the auditory gain and speech perception either acting singly or in combination and the statistical analysis of the present study showed are the age at implantation, duration of auditory deprivation, and the residual hearing which have a direct impact on the outcome over a period of 1 year.
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