Prevalence of cochlear implants in Europe: trend between 2010 and 2016.

Objective: To collect figures on the numbers of children and adults receiving cochlear implants across Europe, compare the figures for 2016 with those for 2010, and identify any trends. Materials and methods: In 2018 EURO-CIU invited their 23 member countries to conduct a survey collecting data on the number of CI recipients in 2016 and 2017. Data were received from 15 countries, representing more than 100 000 CI recipients in Europe. Results: For paediatric CI, there was an increase in nearly all European countries (except Denmark, the UK and Luxembourg) between 2010 and 2016. We found an annual figure of one CI per 1000 newborns common in most countries where reimbursement of paediatric CI's is available. Conversely the adult data reveals no increase between 2010 and 2016 and the data is less homogeneous than the paediatric data with huge differences across countries. Conclusion: There is little agreement on data on numbers of CI across Europe, which makes it difficult to plan public health policy, funding or services. In all European countries included in this study (except Germany) there needs to be work on raising more awareness of adult hearing loss and adult cochlear implantation to improve access.

Cost implications for changing candidacy or access to service within a publicly funded healthcare system?

INTRODUCTION: Undue attention in the allocation of healthcare resources can be given to expenditures as opposed to expenditures avoided. This can be particularly apparent when expenditures avoided fall across different budget holders and budgetary pressures are strained. METHODS: The paper presents estimates of the potential savings attributable to the adoption of new hearing assistive technologies in Britain between 1992 and 2014 based on multivariate analyses of survey data. RESULTS: The reduction in service use among the hearing impaired between 1992 and 2014 is estimated to amount to between £53 and £92 million per annum. CONCLUSION: Issues in estimating the impact of widening candidature for cochlear implants on costs exist related to potential savings. This research begins to lay a firmer evidence base for such work as well as identifying some of the challenges.

Perspectives of adults with cochlear implants on current CI services and daily life.

This paper reports on a survey and interviews carried out with adults who have gone through the cochlear implantation pathway. It explores their experiences of current services, the assessment process for implantation, and the impact on their daily lives, including views and experiences on communication, independence and confidence. It also explores, in today's financially challenging climate, their awareness of current funding issues and the value of their implant to them.

SoundSpace Online: The Development of an Online Resource About Hearing Loss.

PURPOSE: The Internet has been a growing source of health information on hearing loss, but the information provided often varies in quality, readability, and usability. Additionally, the information is provided across a wide range of domains, making access challenging to those who need it. This research forum article describes the development of a new website, SoundSpace Online (Ng, Archbold, Mayer, & Mulla, 2014), which aims to tackle these issues and bring together information and resource s f or all those concerned with hearing loss. METHOD: The SoundSpace Online website's current developmental state was reached through the following methods: (a) discussions with a group of individuals that included experts in e-learning, education, research, and hearing loss; (b) interviews with different target groups (e.g., users, families, and professionals); and (c) collaboration with contributors. RESULT: The website is structured to become a g o-to resource on various topics related to hearing loss, providing accurate, comprehensive, and functional information and resources at varying levels of complexity for the intended users. CONCLUSION: The literature and the range of interest have illustrated the need for an up-to-date website providing information and resources on hearing loss. Challenges include monitoring and keeping the website up to date; in this article, a plan of action is discussed. The website is currently in development, with plans for a launch in the near future.

Cochlear implantation in children with complex needs: the perceptions of professionals at cochlear implant centres.

OBJECTIVE: To explore the views of cochlear implant centre teams about the process of referral, assessment and rehabilitation for children with complex needs. METHODS: An on-line survey of cochlear implant centres in the UK and in the Netherlands was carried out, with both quantitative and qualitative questions. The survey was designed and piloted by four professionals in each country, experienced in working in cochlear implant services, and with complex children. The open qualitative responses were analysed independently for the emergent themes. RESULTS: Seven centres from Netherlands and eight from UK responded. The proportion of children reported with complex needs ranged from under 10% to between 40 and 60%. Children with complex needs were more likely to be later referred than the norm, and to take longer to assess. There was little agreement about the assessments used prior to implantation, or in follow-up. The most commonly seen additional disability was visual, followed by motor/physical challenges and autistic spectrum disorders. The most reported challenge was assessment, followed by parental expectations, and wearing the system. The least reported concern was educational management. The major goal was seen to be hearing and sensory input, rather than speech and language attainment. All centres commented on the importance of parental observation. CONCLUSION: There is a need for a consensus on the assessment of these children, with the development of more objective parent led observation measures to collect long-term data across centres. Closer collaboration with educators, particularly those with other expertise, would facilitate long-term management and asssessment. Data logging, now available, will help monitor wearing and use of system.

Exploring views on current and future cochlear implant service delivery: the perspectives of users, parents and professionals at cochlear implant centres and in the community.

OBJECTIVE: The objective of this survey was to explore the perceptions of implant users/carers and professionals across the UK about current and future cochlear implant service delivery and the challenges. METHODS: Data were collected via an online questionnaire consisting of totally 22 questions. The questionnaire contained both open- and close-ended questions. RESULTS: Totally, seven hundred and forty-eight responses were received. In spite of the wide range of respondents, there was a broad consensus of opinion across groups. The majority of participants were satisfied with the service they currently receive, but wanted some changes. They reported their current experience of implant services to be mainly driven by decisions made by the implant team. For the future, they preferred the service to be mainly driven by decisions made jointly by the team and the user and/or parent/carer. The majority of participants wanted the cochlear implant services to be integrated into local audiology and other services such as education. Restrictions on number of candidates funded and political decisions and issues were seen as major challenges. Qualitative analysis of the open-ended responses supported the questionnaire responses. CONCLUSIONS: This research highlighted the benefits and limitations of the current cochlear implant service delivery as well as the potential implications for the long term. While respondents were generally happy with the current cochlear implant service provision, they expressed some concerns about the long-term sustainability and management, wanting integration into the local services, and more involvement of parents and users in decisions.

LEAPing on with language: An on-line language programme to support classroom teachers and parents of primary school children (aged 5-11 years).

The Leaping on with Language programme provides a combination of strategies and activities to accelerate children's spoken language use from simple sentences to complex language. Using a conversational philosophy it expands the building blocks of language (vocabulary, grammar, speech), whilst emphasising the importance of developing independent social communication and acknowledging a child's developing self esteem and self identity between the ages of 4-11. Three pilot projects evaluated the programme with a total of 51 delegates. The outcomes were hugely positive. Changes in behaviour were reported from the 3rd pilot 1 month later. Comments regarding the length of training, practical strategies and more film clips were implemented. Leaping on with language is now a free to access resource available on line.

The experiences of adults assessed for cochlear implantation who did not proceed.

OBJECTIVE: The objective of this study was to explore, by interview, the experiences of adults who have undergone assessment for cochlear implantation and were considered unsuitable. METHODS: Ten adult participants were interviewed. Interviews were transcribed and thematic content analysis was carried out to analyse them. Six main themes and 16 subthemes were identified. RESULTS: The findings from the study demonstrate that adults who underwent the assessment for cochlear implantation were significantly impacted socially and emotionally as well as at work as a result of their hearing loss. Most participants found the speech testing in the assessment process to be a poor representation of hearing challenges in everyday life. A range of expectations from implantation were noted; the most common one being improvement in speech and communication. The management of these expectations needed attention. After the refusal, participants reported a lack of ongoing support and advice. A number of other suggestions regarding the actual assessment process and aspects around it were highlighted. CONCLUSIONS: A need to revise audiological criteria and modify speech testing methods to resemble hearing challenges in everyday life is highlighted. The impact of hearing loss on social, emotional, and work aspects need to be addressed thoroughly. An awareness of available technology and other coping strategies should be part of the assessment protocol. Uniformity across different centres in terms of providing information pre-assessment needs to be achieved. Consideration of the individual and his hearing and communication needs in addition to formal hearing assessments before deciding/refusing implantation needs to be developed.

Measuring the effectiveness of an audiological counseling program.

OBJECTIVE: Audiologists routinely observe patients struggle with psycho-emotional difficulties associated with hearing loss, yet are often underprepared to manage this vital aspect of patient care. For this reason, a workshop was developed for audiologists interested in expanding their counselling skills. Since one-time workshops typically do not result in changes in practice, this program adopted a distributed-over-time learning model, consisting of 20 hours of participation across six weeks. The extended nature of the program provided multiple opportunities to learn several counselling strategies, and apply and evaluate the effectiveness of these strategies in clinical settings. DESIGN: Learning objectives were assessed throughout the six-week program. However, at the conclusion of each program, it was unknown whether new knowledge carried over into sustained new skills. Therefore, we surveyed attendees six months after their program, to determine if the program had affected changes in their practice. STUDY SAMPLE: Twenty clinicians (response rate = 91%) participated in the survey. RESULTS: All respondents made some, and often many, changes in patient communication. They applied several counseling concepts to their work settings and reported positive changes in patient-clinician dynamics. CONCLUSION: Results suggest that a six-week program is effective in helping clinicians change their counseling skills within their practice.

Adult bone anchored hearing aid services in the United Kingdom: building a consensus for development.

AIMS AND OBJECTIVES: In October 2009, a multi-disciplinary group of UK clinicians met to review issues relating to bone-anchored hearing-aid (BAHA) development. The aim was to help define a model for BAHA services and service development via a process of widespread consultation with UK BAHA professionals. METHODS: A modified Delphi technique was used. Statements were proposed by the lead group and sent out for consultation. Those with ≥90% agreement were approved without further discussion. Statements with 50-89% agreement were discussed by the lead group to determine whether they should be included in the final document. Any statement with <50% agreement was removed without discussion. A second consultation was then made, and the process repeated. This led to a final set of consensus statements. RESULTS: The final consensus comprises 33 statements validated by the modified Delphi process. All of these statements achieved >75% agreement, with only six statements having <90% agreement. When these statements were presented to the UK BAHA Professionals group at their annual conference there was 89% agreement from the group for the consensus statements to be accepted. DISCUSSION: The levels of agreement for the final questionnaire show that the mandate for the consensus statements was exceptionally high. Implementation of the consensus is discussed, as are each of the key areas of the consensus, such as funding and minimum assessment standards.

Long-term use of cochlear implant systems in paediatric recipients and factors contributing to non-use.

The aim of the present paper was to assess children's long-term use of their cochlear implant systems and to explore factors influencing the extent of daily use. The parents of 138 deaf children who had been implanted for seven years completed an annual questionnaire about the extent of their child's use of their implant system. The results revealed that seven years after implantation 115 children (83%) were wearing their implants full-time, 16 (12%) most of the time, three (2%) some of the time and four (3%) were non-users. The children were categorised into those who were full-time users (group F) and those who were not full-time users (group N). The mean age at implantation in group F was 4.4 years with a median of four whereas in group N the mean age at implantation was 5.8 years with a median of 5.5 years. This difference was highly statistically significant. There were no children who were total non-users implanted below the age of five. The predominant mode of communication was oral in group F and signed communication in group N and the difference was also statistically significant. In group F, 90 (78%) were in mainstream education, either mainstream school or a resource base in a mainstream school, whereas the respective percentage in group N was 57 per cent and this difference was statistically significant. Further investigation of those in group N shows a fluctuating pattern of use over the years prior to becoming complete non-users seven years after implantation. The four children who were complete non-users at seven years after implantation were all implanted at five and had other difficulties with all having complex family issues, three having significant other learning difficulties and one experiencing pain on stimulation. None had experienced device failure. In conclusion, this study of 138 children showed very high levels of full-time use seven years after implantation. Factors linked with full-time use seven years after implantation were early implantation, oral mode of communication and mainstream educational placement. Additional difficulties were not significant. Psycho-social issues such as family and educational support appeared to be important in facilitating continued use of the implant system. Non-use may occur after several years of use and in this group non-use followed a fluctuating pattern of use over time. The regular monitoring of device use may enable cochlear implant teams to be alert to potential non-users and to provide appropriate and timely support to the child, family and educational service.

Children with cochlear implants: the communication journey.

Cochlear implantation is now a well-established procedure for profoundly deaf children providing access to speech through hearing for many of them. Much attention has focused on which communication mode to adopt with this group of children but very little work has looked at the choices that parents make before and after cochlear implantation. This study, following on from two earlier studies, looked in depth at the experiences of 12 families. It finds that parents choose the most effective way of communicating with their child but retain as their goal, the development of oral communication skills. For many this is a journey in which different approaches are utilised at various stages in the child's development.

Speech production in deaf implanted children with additional disabilities and comparison with age-equivalent implanted children without such disorders.

OBJECTIVE: To assess the long-term speech intelligibility in implanted children with additional disorders and compare them with age-equivalent implanted children without such disorders. PATIENTS: 175 profoundly deaf children 5 years following cochlear implantation; 67 children with additional difficulties and 108 children without such difficulties. All children were implanted under 5-year-old. MAIN OUTCOME MEASURE: Speech intelligibility rating (SIR) scale that can be readily applied to young deaf children irrespective of their performance and is reliable between observers. RESULTS: Five years following implantation, 47 (70%) children with additional difficulties developed connected intelligible speech versus 104 (96%) in the control group. However, the quality of speech was quite different between the two groups, as only 11 (16%) children with additional difficulties achieved the two higher categories (intelligible to all or to people with little experience), whereas 66 (61%) children in the control group did (P<0.000001). The total number of additional disorders had the strongest correlation with the outcome. Language and communication disorders were the most important contributing factor, followed by physical, cognitive, and autistic spectrum disorders. CONCLUSION: The majority of deaf children with additional disorders develop connected intelligible speech 5 years following implantation; however, a significant proportion do not develop any speech at all. Thus a third of this group did not realise one of the most important objectives for parents of implantation. Benefit from implantation should not be restricted to speech production alone in this specific population.

Reading abilities after cochlear implantation: the effect of age at implantation on outcomes at 5 and 7 years after implantation.

OBJECTIVES: The reading skills of deaf children have typically been delayed and this delay has been found to increase with age. This study explored the reading ability of a large group of children who had received cochlear implants 7 years earlier and investigated the relationship between reading ability and age at implantation. METHODS: The reading ages of 105 children, with age at implantation less than 7 years and onset of deafness below the age of three, were assessed 5 and 7 years after implantation using the Edinburgh reading test. Net reading age was calculated by using the difference between chronological age and reading age. Non-verbal intelligence was measured for a subset of 71 children, using Raven's coloured progressive matrices. Further investigation of this subset looked at the association of nonverbal intelligence, age at implantation and reading ability. RESULTS: There was a strong negative correlation at both 5 and 7 years after implant between net reading score and age at implantation. In the subset of 71 children who had an IQ score within normal range, those implanted at or before 42 months had age-appropriate reading both 5 and 7 years post-implant. This was not the case for children implanted after 42 months. Reading progress at the two post-implant assessment intervals were found to be highly related. CONCLUSIONS: Age at implantation was a significant factor in the development of reading skills in this group. In children implanted below the age of 42 months, reading progress was in line with chronological age, which has not been the case previously with profoundly deaf children. With earlier implantation more common in present groups, and improved technology, there is every reason to be optimistic about the influence of cochlear implantation on the development of reading skills in deaf children.

Parents' views on changing communication after cochlear implantation.

We sent questionnaires to families of all 288 children who had received cochlear implants at one center in the United Kingdom at least 5 years previously. Thus, it was a large, unselected group. We received 142 replies and 119 indicated that the child and family had changed their communication approach following cochlear implantation. In 113 cases the change was toward spoken language and in 6 cases the change was toward signed communication. Parents were asked to respond to statements about communication with their deaf child, and their responses indicated that parents wanted the most effective means of communication and one that their child would find most useful in the future. Findings that emerged from parents' comments indicated that the change toward greater use of spoken language was child-led and driven by increased audition. Parents also valued the contribution of signed communication.

Ensuring the long-term use of cochlear implants in children: the importance of engaging local resources and expertise.

Cochlear implantation for children is now a mature service, recognized as being safe and effective. Early identification is enabling implantation to be undertaken in the first years of life, with the likelihood of better outcomes. Traditional models of service delivery provided excellent clinic-based services, with intensive early habilitation. However, the current challenges extend beyond this time frame, and clinic-based services are overstretched with the growing numbers of children with implants. Needs analyses of parents and teachers in Europe provide evidence that they are keen to have regular links between implant center and home and school and that for both parents and teachers a major concern is the long-term management of the technology. There are major challenges, not in the implant clinic, but at home and school where implant systems are used. Implementing complex technology in the child's community in the long term is only possible by engaging parents and the local professionals, particularly teachers, from the outset, and using their expertise. This calls for a critical appraisal of the traditional approach to service delivery. Such engagement of local professionals does not happen automatically but can be achieved by educational programs for parents and local professionals that are adapted to local needs and cultures. Communication between implant center and home and school is essential, ensuring that the technology of implantation is used effectively at all times and is accessible to all wherever they live. This article recommends ways in which parents, teachers, and local professionals can play a central role in the management of children with implants to ensure the successful long-term use of their implant systems. Engaging and using the skills and expertise of those who know the child best, parents and teachers, will not only ensure that implantation is sustainable in the long term in diverse cultures, but is also cost-effective.

Cochlear implants: the young people's perspective.

Cochlear implantation is a relatively new procedure, which has already had significant impact on the lives of many profoundly deaf children and adults, in providing useful hearing to those unable to benefit significantly from hearing aids. After 16 years of cochlear implantation in the United Kingdom, there is now a body of evidence covering a range of outcomes, much of which covers perceptual and linguistic outcomes. This study looks at the impact of cochlear implantation on a group of 29 young people aged 13-16 years, using a semistructured questionnaire. It examines issues from the perspective of the young people themselves, including their understanding of and degree of satisfaction with the way their implant works for them, their social and communication abilities and choices, their educational challenges, and their identity. It concludes that the young people in this group feel positive toward their cochlear implants and the decisions made on their behalf by parents. Many have a flexible attitude to communication modes and an identity which is not fixed in terms of conventional descriptors.