The Study On Auditory And Language Development And Health-Related Quality Of Life In Mandarin-speaking Children With Cochlear Implants

Cochlear implant(CI)is an effective treatment allowing children with severe to profound sensiorneurial hearing loss to achieve substantial development in auditory and language abilities.Along with the enhanced skill in surgical technique and the increased financial support from national government and social enterprise,more and more prelingual deaf children became CI recipients and benefited from it.The increased CI population urges the evaluation on the progress in auditory and language skills as well as other benefits such as school achievement and improvement in quality of life.However,the most directly demonstration of the benefits after receiving Cl is to assess the development in auditory and language performance.The results can not only provide useful information in clinical reference and rehabilitation schedule but also can lay the basis for improvement in CI technique and speech code strategy.The impact of CI on prelingual deaf children extends beyond progress in auditory perception,speech recognition and language production to encompass day-to-day issues such as increased social well-being and social involvement.Health-related quality of life(HRQoL)provides a mechanism to assess the multi-dimensional impact of Cl on an implanted child's daily life.When evaluating the post-implantation benefits in prelingual deaf children,we should focus on both auditory and language performance as well as HRQoL.Part 1 Early Auditory and Language Development in Mandarin-Speaking Children after Cochlear ImplantationObjectiveTo evaluate early auditory performance,speech perception and language skills in Mandarin-speaking prelingual deaf children in the first two years after they received a CI and analyse the effects of possible associated factors.MethodsThe Infant-Toddler Meaningful Auditory Integration Scale(ITMAIS)/Meaningful Auditory Integration Scale(MAIS),Mandarin Early Speech Perception(MESP)test and Putonghua Communicative Development Inventory(PCDI)were used to assess auditory and language outcomes in 132 Mandarin-speaking children with CIs at pre-implantation and at 3-,6-,9-,12-,18-and 24-month intervals after CI activation.ResultsChildren with CIs exhibited an ITMAIS/MAIS and PCDI developmental trajectory similar to that of children with normal hearing.There were significant improvements in ITMAIS/MAIS scores between two successive test intervals(P<0.05).Children with CIs showed comparable ITMAIS/MAIS scores to the normative values during the first year after implantation(P>0.05).However,their scores were lower than normative values at 18 and 24 months after CI activation<(P<0.05).The increased number of participants who achieved MESP categories 1-6 at each test interval showed a significant improvement in speech perception by paediatric Cl recipients.Children with CIs experienced gradual development of receptive and expressive vocabulary from pre-implantation to two years after implantation.Children with CIs attained higher receptive vocabulary scores in the first 6 months after CI when compared with normative values(P<0.05)and suimilar scores in the next 6 months(P>0.05).Their mean expressive vocabulary scores far exceeded those of children with normal hearing during the first year after CI(P<0.05).However,their scores lagged behind the normative values at 18 and 24 months post-implantation(P<0.05).Age at implantation,multilingualism and parental education were consistently associated with both auditory and language outcomes in the first two years post-implantation.ConclusionsMandarin-speaking children with CIs exhibit significant improvements in early auditory and language development.Though these improvements followed the normative developmental trajectories,they still exhibited a gap compared with normative values.Earlier implantation,momolingualism and higher parental education are consistent predictors of greater auditory and language skills in the early stage post-implantation.Part 2 Long-term Speech Perception and Language Skills in Mandarin-speaking Children with Cochlear ImplantsObjectiveTo investigate long-term open-set word recognition and language skills in Mandarin-speaking children with CIs and the predictors of the outcomes,and to explore the relationship between children's word recogniton and their receptive and expressive language skills.MethodsA sample of 61 prelingual deaf children who received CI at our department were recruited in the study.61 children with normal hearing matched in age and sex were served as control group.Mandarin lexical neighborhood test(M-LNT)was used to evaluate the open-set word identification performance in children with CIs and children with normal hearing and Revised Preschool/Primary School Language Assessment Test for their receptive and expressive language skills.ResultsChildren with CIs showed higher identification scores in easy word than in hard word,as well as higher scores in disyllabic words than in monosyllabic word.Children with CIs demonstrated lower identification scores compared with those of children with normal hearings.Children with CIs also showed lower scores in receptive and expressive language performance when compared with normal hearing peers.A significant correlation was found between open-set word recognition and receptive and expressive language skills.Age at implantation,CI duration,multilingualism and parental education were revealed to be associated with the outcomes of speech perception and receptive and expressive language skills.ConclusionsChildren with CIs achieved progress in long-term speech recognition and receptive and expressive language skills in various degree.However,their performance still exhibited a gap compared with that of children with normal hearings.A significant correlation was found between speech identification and receptive and expressive language skills.Age at implantation,CI duration,multilingualisrm and parental education were related to the long-term outcomes of speech recognition and receptive and expressive language skills post-implantation.Part 3 Health-Related Quality of Life in Mandarin-speaking Children with Cochlear ImplantsObjectiveTo evaluate HRQoL in Mandarin-speaking children with CIs and analyse the correlation between their HRQoL and speech recognition and language performance.MethodsThis study consisted of two groups of participants.Study group recruited 61 prelingual deaf children with CIs and their parents.Control group consisted of 61 age and sex matched children with normal hearing and their parents.Parents and children were surveyed using KINDL,which is a generic measurement for assessing the HRQoL.A CI specific questionnaire was also conducted.ResultsChildren with CIs reported their HRQoL scores higher than their parents(P<0.05).Children with CI reported their HRQoL scores were comparable to their normal hearing peers(P>0.05).CI specific questionnaire revealed that environmental awareness and speech recognition were the most benefit as rated by children with CIs and their parents respectively.Both children with CIs and their parents rated speech recognition in noise as the most problematic item.No significant correlation was found between HRQoL scores and speech recognition and language scores.ConclusionsChildren with CIs rate overall HRQoL measures similar to their hearing peers.Parents and children with CIs reported that benefit outweigh problems in device usage.Children with CIs exhibited improvement in HRQoL without depending on the progress in auditory and language performance.Preschool and school-aged children with CIs could adequately assess their own HRQoL.