ABSTRACT
Background: As per the World Health Organization 2018, the new estimate of disabling of hearing loss is 466 million people.The State Initiative on Disabilities Survey (2015), Kerala, India, indicates that 2.32% of populations in Kerala, India, are affectedby some form of disabilities. Among them, 60,925 are hearing disabled based on the definition of hearing impairment in thePersons with Disabilities Act 1995. A cochlear implant (CI) is a surgically implanted electronic device that provides a sense ofsound to a person with severe to profound sensorineural hearing loss in both ears.Need for the Study: Even though the Sruthitharangam scheme was started by the Government of Kerala, India, in 2012, no studywas carried out to estimate the outcomes in terms of usage of CI, education placement, and mode of communication after CI surgery.Aims and Objectives: The aim of the study was to investigate the usage of CI, communication abilities, and schooling in CIchildren who have undergone surgery under Kerala Government free CI program. The current study was to report the usageof cochlear implantation, the education status, and mode of communication of the children who had undergone, free of cost CIsurgery from June 2012 to December 2015 in Kerala, India.Materials and Methods: The demographical data were collected from the register maintained at Government Medical College,Kozhikode, Kerala, India. The study was a cross-sectional study and the data were collected through the telephonic interview of 114parents or caregivers among 132 parents who had undergone free CI surgery from June 2012 to December 2015 at GovernmentMedical College Kozhikode. Eighteen parents or caregivers could not be contacted due to unavailability or change of contact numberand data collection was possible only for 114 parents among the 132 parents. All the children had attended a minimum of 2 years ofpost-implantation Auditory-Verbal Habilitation (AVH) from Sruthitharangam empanelled centers. Each subject was asked questionsto understand the current usage of the device, the mode of communication, type of schooling, and associated issues that affect theprognosis of CI is also considered. The obtained responses were scored accordingly and tabulated for further statistical analysis.Observations and Results: The result reveals that among the 114 CI recipients, 93.8% (107 recipients) were using CI and 6.14%(seven recipients) were non-users. These data found that all children were enrolled in school and attending in variety of educationalsettings. In that, 82.45% (94 children) were attending mainstream education and 17.54% (20 children) were going to specialschools. On further analysis of the communication, abilities showed that the majority of the children (75.43%) communicated orally,21.05% of them communicated through total communication and 3.5% of them used sign language.Conclusions: Kerala government Sruthitharangam CI program aid the majority of the children with severe to profoundsensorineural hearing loss in acquiring oral communication skills and also benefiting integration in normal schools. Steps shouldbe taken to reduce the number of non- users and also plan new strategies for better normal school integration for CI childrenunder the government scheme
ABSTRACT
Background: Cochlear Implantation (CI) has become an important modality of treatment for children with severe to profoundpre-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 factorson the final outcome of the CI in pre-lingual hearing impaired children aged 5 years under “Sruthitharangam” free cochlearimplant program of Government of Kerala.Materials and Methods: This study was conducted at Government Medical College, Kozhikode (GMC-KKD), Kerala, fromJanuary 2014 to January 2015. The study group consisted of 60 patients screened from the patients who have attendedAuditory 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-upsand therapy/support to the child at home.Observations and Results: Pearson correlation test and Spearman correlation test were done to check the correlation betweenage 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 residualhearing and stimulation of auditory nerve as early as possible. Pearson correlation and Spearman correlation tests were appliedto check the correlation between age of surgery and MAIS score and found that there was negative correlation existing betweenage 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 ordefective 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 eitheracting singly or in combination and the statistical analysis of the present study showed are the age at implantation, duration ofauditory deprivation, and the residual hearing which have a direct impact on the outcome over a period of 1 year.