Perceived social support improves health-related quality of life in cochlear implant patients.

PURPOSE: Perceived social support has been shown to positively correlate with health-related quality of life (HR-QoL) in a variety of conditions. This study investigated whether perceived social support is affecting HR-QoL of patients who receive a cochlear implant (CI) for deafness. METHODS: Eighty eight adults (56 males, 32 females; mean age: 60 years) with a uni- or bilateral CI for bilateral high-grade hearing loss were administered two questionnaires: a questionnaire for perceived social support (FSU-14) and the Nijmegen Cochlear Implant Questionnaire (NCIQ) for hearing-specific HR-QoL. Administration of the questionnaires occurred at four points in time: before implantation and three, 12 and 24 months after implant activation. RESULTS: The CI patients had quite high levels of perceived social support (mean percentile rank: 71), which remained stable at all four measurement points. Multivariate Analysis showed a significant interaction between perceived social support and HR-QoL indicating that higher perceived social support lead to higher improvement of HR-QoL after cochlear implantation. CONCLUSION: The CI patients in this study had higher than average levels of perceived social support, which did not change before and after cochlear implantation. Perceived social support and HR-QoL were related such that patients with high levels of perceived social support experienced greater improvement of their HR-QoL after cochlear implantation than patients with low levels of perceived social support. Based on this finding, perceived social support must be considered as an important factor for HR-QoL after cochlear implantation.

[Development of a German short version of the Nijmegen Cochlear Implant Questionnaire]. / Konstruktion einer Kurzversion des Nijmegen Cochlear Implant Questionnaire in deutscher Sprache.

BACKGROUND: The Nijmegen Cochlear Implant Questionnaire (NCIQ) is a questionnaire for assessing hearing-specific quality of life in the context of cochlear implantation. Its length (60 items) makes it difficult to use in clinical practice, so a short version is desirable. The question arises as to which items should be selected for the short version. METHODS: The items were selected statistically using uncorrected item-total score correlation. Item selection was made based on datasets from three measurement points: before implantation and 3 and 12 months after processor activation. The items were selected according to the criterion that they were among the 40 items with the highest item-total score correlation at each of the three measurement points. RESULTS: Of the 60 items in the NCIQ, 25 met the criterion and were hence included in the short version. The short version yields similar scores as the long version at the postoperative timepoints; however, at the preoperative timepoint, the agreement of the scores is suboptimal. Split-half reliability and internal homogeneity of the short version are very good. CONCLUSION: The present study constitutes an initial positive evaluation of a short form of the NCIQ in terms of standard psychometric criteria. Application of the short form is associated with significantly reduced resources in terms of processing and evaluating.

5-Year Observation Period of Quality of Life After Cochlear Implantation.

BACKGROUND: Only few studies assessed health-related quality of life (HRQoL) in cochlear implant (CI) patients for a period of more than 2 years. Some of these studies indicated that HRQoL might decrease after that period. The goal of our study was to see whether HRQoL indeed decreases or remains stable beyond 2 years after implant activation. METHODS: Twenty-five adults (11 women, 14 men; mean age at implantation: 60 ± 19 yr) with a unilateral CI for profound hearing loss were administered two questionnaires: the Nimjegen Cochlear Implant Questionnaire and the Health Utility Index 3 (HUI 3). The Nimjegen Cochlear Implant Questionnaire total score and the HUI single-attribute utility score of Hearing are measures of hearing-specific HRQoL, whereas the HUI multiattribute utility score is a measure of generic HRQoL. The questionnaires were administered before cochlear implantation and 1, 2, and 5 years after implant activation. RESULTS: Hearing-specific HRQoL was significantly improved at 1 year after implant activation and did not significantly change thereafter. Generic HRQoL also showed significant improvement at 1 year after implant activation, but deteriorated to a clinically relevant degree thereafter. CONCLUSIONS: The significant improvement of hearing-specific HRQoL obtained from cochlear implantation was fully maintained for up to 5 years after implantation. Generic HRQoL of our CI patients, however, fluctuated over time. The decrease of generic HRQoL is supposed to reflect general age-associated health declines.

Cost-utility Analysis of Cochlear Implantation in Adults With Single-sided Deafness: Austrian and German Perspective.

BACKGROUND: Single-sided deafness (SSD) is associated with a loss of binaural hearing. Major limitations of such patients are poor speech understanding in noisy environments and a lack of spatial hearing. To date, cochlear implantation is the most promising approach to overcome these deficits in this group of patients. OBJECTIVE: Cost-effectiveness analyses of cochlear implantation in patients with unilateral deafness. The model targets Austrian and German SSD patients who can either opt for treatment with a cochlear implant (CI) or decide against a CI and stay without any treatment. METHODS: A Markov model analyzed as microsimulation was developed using TreeAge Pro 2019 software. Pre- and postoperative utility values generated with HUI-3 were used to populate the model. Costs covered by the national insurance were considered. Costs and utilities were discounted by 3%. A model time horizon of 20 years was set. RESULTS: According to Austrian base-case analysis, the incremental cost-utility ratio (ICUR) was €34845.2 per quality-adjusted life year gained when comparing the "CI strategy" to the "no treatment strategy." The ICUR is marginally lower when adapting a German cost perspective-it was €31601.25 per quality-adjusted life year gained. Sensitivity analyses showed that the cost-effectiveness results are stable. Analyses also showed that the longer the time horizon is set, the more favorable the cost-effectiveness result is. CONCLUSIONS: Based on currently available data, the Markov microsimulation model suggests that cochlear implantation is cost-effective in Austrian and German patients with SSD if no other treatment option is considered within the model.

Does Cochlear Implantation Affect Openness-to-Experience in Profound Postlingual Hearing Loss?

Recent studies suggest that hearing loss in postlingually deafened adults may be associated with lowered levels of the personality factor Openness to experience. This study investigated whether cochlear implantation in postlingually deafened adults raises the level of Openness to experience. Fifty-five postlingually deafened adults (mean age: 63 years) were assessed with the Neuroticism-Extraversion-Openness-Five-Factor-Inventory (NEO-FFI), a questionnaire capturing the five personality factors Extraversion, Openness to experience, Neuroticism, Agreeableness, and Conscientiousness. Personality assessment occurred before cochlear implantation and 24 months after implant activation. On factors Extraversion, Neuroticism, Agreeableness, and Conscientiousness the mean scores of the sample were equal to population norms, both before and after cochlear implantation. On factor Openness to experience, the mean score was significantly lower before cochlear implantation, and remained so thereafter. Openness to experience may be reduced in some groups of deaf or hard of hearing persons. Cochlear implantation had no effect on any personality factor, at least not after two years of implant use.

Subjective Hearing Impression and Quality of Life in Patients With Bilateral Active Middle Ear Implants.

OBJECTIVE: This study compared the quality of life in patients with bilateral active middle ear implants to their quality of life when they were unilaterally implanted. DESIGN: Twenty-one patients implanted sequentially with the Vibrant Soundbridge (VSB) active middle ear implant completed quality-of-life surveys. The patients were asked to rate whether and to what extent their quality of life has changed upon receiving a second VSB. Hearing-specific quality of life was assessed with the Speech, Spatial, and Qualities of Hearing Scale (SSQ12-B), and general quality of life was with the Glasgow Benefit Inventory (GBI). In addition, the patients completed a health-related quality-of-life questionnaire (AQoL-8D). Finally, the changes in hearing-related and general quality of life were correlated to the change in word recognition ability after implantation of the second VSB (Freiburg monosyllabic word test; unilateral VSB versus bilateral VSB at 65 dB SPL). RESULTS: On the SSQ12, subjects scored a median of + 2.73 (p < 0.001; significantly different from zero) on a scale of -5 to + 5 where 0 indicates no change. All three subscores showed significant improvement. On the GBI, patients reached a median overall score of + 23.6 (p < 0.001; significantly different from zero) on a scale of -100 to + 100 where 0 indicates no change. Here, the improvement was mainly visible in the general subscore, whereas the social support and physical health subscores did not change due to the intervention. Both subjective benefit rating scores strongly correlated with the change in word recognition scores, suggesting that both hearing and general quality of life improved with increased word recognition due to bilateral VSB use. No significant correlation was found between the subjects' general health (as measured by AQoL-8D utility scores) and SSQ12-B or GBI overall scores. CONCLUSION: Usage of a second active middle ear implant substantially improved our patients' subjective hearing and general quality of life compared with unilateral use. The increase in quality of life may be linked to improved speech understanding due to bilateral use of a middle ear implant. Furthermore, these outcomes were not influenced by our patients' general health state at the time of survey.

Cochlear implantation in adults with single-sided deafness: generic and disease-specific long-term quality of life.

PURPOSE: To determine the 2-year outcome of health-related quality of life (HRQoL) in adults who received a cochlear implant (CI) for single-sided deafness (SSD). METHODS: Twenty adults (mean age at implantation: 47 ± 11 years) with SSD (PTA worse ear: 113 dB HL, PTA better ear: 14 dB HL) were administered the Nijmegen Cochlear Implant Questionnaire (NCIQ), and the Health Utility Index 3 (HUI 3). Questionnaire administration occurred before cochlear implantation and 3, 6, 12, and 24 months after implant activation. RESULTS: Of the 20 patients, 2 discontinued CI use within the observation period due to poor benefit. The NCIQ total score of the sample increased significantly over time (p = 0.003). The largest increase occurred within the first 3 months of CI use. Also, the HUI 3 multi-attribute utility score increased significantly (p = 0.03). The post-treatment increase of this score (+ 0.11 points) indicated that the gain in HRQoL was clinically relevant. Patients with a duration of deafness > 10 years had in all measures an equal HRQoL improvement than had patients with a duration of deafness < 10 years. CONCLUSION: Cochlear implantation led to significant improvement of hearing-specific and generic HRQoL in our patients. The improvement was seen after 3 or 6 months but did not increase further at later intervals. Patients with long-lasting SSD may be at higher risk of discontinuing CI use. However, if they adapt to the CI, they can experience an equal increase of HRQoL as patients with a short duration of SSD.

Do Personality Factors Assessed Before Cochlear Implantation Predict Hearing-Related Quality Of Life After Cochlear Implantation in Postlingually Deafened Adults?

BACKGROUND: Studies have shown that cochlear implants improve deaf patients' hearing-related quality of life (hrQoL), but the degree of improvement varies considerably between patients. This study investigated whether personality factors contribute to hrQoL outcome after cochlear implantation. METHOD: Fifty adult patients with postlingual hearing loss who received a unilateral cochlear implant were administered the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI; a personality inventory) and the Nijmegen Cochlear Implant Questionnaire (NCIQ; a hrQoL questionnaire). The NEO-FFI was administered only before implantation; the NCIQ was administered before implantation and 12 months after implant activation. A linear regression analysis was computed to detect whether NCIQ scores at 12 months were predicted by the NEO-FFI personality factors (i.e., Extraversion, Neuroticism, Openness to Experience, Agreeableness, and Conscientiousness) assessed before implantation. RESULTS: HrQoL scores had significantly improved 12 months after cochlear implantation in all subdomains of the NCIQ. Of the five personality factors, solely Neuroticism was negatively associated to the NCIQ subdomain self-esteem (ß = -0.34; p = 0.013) at 12 months after cochlear implantation. CONCLUSIONS: While significant improvement of hrQoL was seen 12 months after implant activation, this improvement was barely predicted by the Big-Five personality traits measured before implantation. Only Neuroticism was found to moderately influence postimplantation hrQoL in our patients, in the way that higher degrees of Neuroticism tend to go along with lower degrees of self-esteem (as conceptualized by the NCIQ). The failure to detect personality effects on hrQoL could partly be due to the low levels of Extraversion and Openness to Experience observed in our sample of patients with hearing loss.

Auditory and cognitive development in a partially deaf child with bilateral electro-acoustic stimulation: a case study.

OBJECTIVE: To study the long-term evolution of speech and intelligence in a child with partial deafness and normal hearing in the low frequencies after sequentially receiving cochlear implants in both ears. DESIGN: Retrospective chart review. STUDY SAMPLE: Male child aged 6 years was followed over a time period of four years. RESULTS: The paediatric patient had normal hearing up to 1 kHz and profound hearing loss at all higher frequencies symmetrical in both ears. Deprivation of high-frequency sounds resulted in retarded development of speech, language and cognitive skills. The choice for rehabilitation was cochlear implantation with the aim of preserving a considerable amount of low-frequency hearing. With natural hearing at low frequencies and electrical stimulation at high frequencies, the child was able to compensate most of his developmental deficits. Moreover, spatial hearing was almost normal. CONCLUSIONS: Electro-natural stimulation without amplification of the low frequencies (electro-natural hearing) provides access to the whole audible frequency range for children, who suffer from partial deafness in the high frequencies and are normal hearing at low frequencies. Such provision allows for regular speech development and favours the development of spatial hearing. The case report also demonstrates a strong impact on intellectual performance.

Improvement of sound source localization abilities in patients bilaterally supplied with active middle ear implants.

CONCLUSIONS: Patients, who are bilaterally supplied with active middle ear implants, perform slightly better in sound localization tasks than when unilaterally aided or unaided. OBJECTIVES: To investigate the impact of bilateral use of active middle ear implants on sound source localization in the horizontal plane in patients with a sloping moderate-to-severe hearing loss. METHODS: Ten adults supplied with Med-EL Vibrant Soundbridge systems (VSB) in both ears participated in the study. Four listening conditions were tested: unaided, aided with VSB on left or right ear and on both sides. In each condition the subjects had to judge the direction of broadband noises delivered randomly across a semicircular array of 11 loudspeakers arranged in an anechoic chamber. RESULTS: When unaided or bilaterally aided, the subjects localized on average 40% of the stimuli correct; when unilaterally aided (left or right), this rate dropped to 20-30% in either condition. Precision of sound localization was highest when bilaterally aided, i.e. the mean RMS angular error was 10°, and lowest when unilaterally aided, i.e. 15°. This is in line with bilateral hearing aid users, who show similar performance in sound localization tasks.

Results from high-frequency hearing screening in 14- to 15-year old adolescents and their relation to self-reported exposure to loud music.

OBJECTIVE: Data from high-frequency hearing screening in adolescent students were analysed to investigate whether practices of listening to loud music are reflected in the hearing status of young people. DESIGN: Students were screened for their hearing at frequencies 2, 4, and 6 kHz and at a level of 20 dB HL. Failure of the screening was defined by missing at least one frequency in one ear. In addition to hearing screening, the students filled out a questionnaire asking for practices related to exposure to loud music. STUDY SAMPLE: 1296 adolescents aged 14 to 15 years. RESULTS: The overall rate of failing the hearing screening was 14.9% (95% CI: 13.0%-16.8%). The rate was similar in adolescents with no, little, or moderate exposure to loud music (10% to 15%), but significantly increased (22% to 25%) in adolescents with high exposure. CONCLUSIONS: The observed failing rate compares well to findings on the prevalence of hearing deficits in adolescents reported in other studies. In addition, our study suggests that the risk for hearing damage from loud music is not steadily increasing with increase of exposure, but exists only under conditions of extreme listening.

Can a hearing education campaign for adolescents change their music listening behavior?

This study looked at whether a hearing education campaign would have behavioral effects on the music listening practices of high school students. A total of 1757 students participated in a hearing education campaign. Before the campaign and one year thereafter they completed a survey asking for: (1) average frequency of discotheque attendance, (2) average duration of stay in the discotheque, (3) use of earplugs in discotheques, (4) frequency of regeneration breaks while at a discotheque, and (5) mean time per week spent listening to music through headphones. On questions (2), (3) and (5) no relevant post-campaign changes were reported. On question (1) students' answers indicated that the frequency of discotheque attendance had even increased after the campaign. The only change in keeping with the purpose of the campaign was an increase in the number of regeneration breaks when at a discotheque. The effect of hearing education campaigns on music listening behavior is questioned. Additional efforts are suggested to encourage adolescents to adopt protective behaviors.

Social stigmatization in patients with cranial and cervical dystonia.

Patients with cranial and cervical dystonia (CCD) suffer from visible involuntary facial, head, and neck movements. Therefore, the social appearance of patients with CCD may be seriously affected and self-perceived stigma can be a major source of disability. The present study investigated enacted social stigmatization of patients with CCD. In a pilot study, a semantic differential scale for assessment of stigma was constructed and validated. The final scale contained eight items representing personality traits to be rated on a seven-point scale (-3 negative extreme to 3 positive extreme). Short video sequences (15 seconds) of patients with various types of CCD and age- and sex-matched healthy controls were presented to a sample of 80 biology students (mean age, 19.8 +/- 2.3 years). Immediately after presentation of each video sequence, the students were asked to perform stigma ratings. Significant differences between CCD patients and controls were found on all eight items (P < 0.001 for each). CCD patients were rated as less accountable for their actions, less likeable, less trustworthy, less attractive, less self-confident, more odd and different, more reserved, and more piteous than controls. CCD patients are subject to serious prejudice and enacted stigmatization. There is a need for informing the public about the nature and symptoms of this disorder and a need to support patients to cope with stigmatization.

Universal newborn hearing screening and postnatal hearing loss.

OBJECTIVE: The goal of this study was to determine the percentage of children who have a postnatal permanent childhood hearing impairment (PCHI) and the percentage thereof who have risk indicators for a postnatal hearing loss. METHODS: Data were drawn retrospectively from the clinical charts of children who had bilateral PCHI (>40 dB hearing level, better ear, unaided) and had undergone universal newborn hearing screening (UNHS) between 1995 and 2000 in various Austrian hospitals. A hearing loss was recognized as postnatal when a child passed UNHS but was later found to have a hearing impairment. The presence of risk indicators, as suggested by the Year 2000 Statement of the American Joint Committee on Infant Hearing (JCIH), was assessed by reviewing the children's clinical charts. RESULTS: Of a total of 105 children with bilateral PCHI, 23 (22%) showed postnatal impairment. After correction of this number for underascertainment, postnatal impairment was estimated to account for 25% of all bilateral PCHI at age 9 years. Risk indicators were found in 17 children but did not fully correspond to those proposed by the JCIH. The risk factors found were a family history of hearing loss (3 children), meningitis (2), craniofacial malformation (2), persistent pulmonary hypertension (1), congenital cytomegaly infection (1), extracorporeal membrane oxygenation (1), recurrent otitis media with effusion (1), and, in addition to the JCIH list, ototoxic therapy (5), and birth before 33rd gestational week (2) (1 child had a combination of the last 2). Six children showed no risk indicators for the postnatal hearing loss. CONCLUSIONS: Our findings suggest that approximately 25% of bilateral childhood hearing loss is postnatal, which supports the leading role of UNHS in detecting PCHI. Provisions for also identifying postnatal cases nevertheless are justified. Because in some of these children no risk indicators are detectable and in others the hearing deterioration starts after age 3 years, audiologic monitoring of at-risk children up to this age may not be sufficient. Additional methods, such as hearing screening at nursery schools or schools, are recommended.

Ten-year outcome of newborn hearing screening in Austria.

OBJECTIVE: Current health care standards recommend that congenital hearing loss be confirmed before age three months and intervened for before age six months. This study evaluated to what extent the Austrian universal neonatal hearing screening (UNHS) program achieves this goal. The Austrian UNHS program is a hospital-based, two-stage screen based on transient oto-acoustic emissions, as promoted in 1995 in a position paper of the Austrian ENT Society. METHODS: Retrospective chart review and data analysis. All Austrian institutions engaged in the diagnosis and treatment of childhood hearing loss were requested to provide their data on children with permanent congenital sensorineural hearing impairment registered since 1990. Children who had undergone hearing screening, were compared to those who had not. Main outcome measures were age at confirmation of and age at intervention for the hearing loss. In each group, the percentage of children, whose hearing loss was confirmed by age three months, and intervened for by age six months, was determined. RESULTS: Data from 321 hearing-impaired children were useable. Of these children, 167 were screened and 154 were not. At age three months, a hearing loss was diagnosed in 35% of screened children, but in only 2% of unscreened. These percentages rose to 69% and 6%, respectively, at age six months and to 81% and 12%, respectively, at age one year. Intervention mostly started within less than one month after diagnosis. At age six months, 61% of screened children, but only 4% of unscreened children, had undergone intervention. CONCLUSIONS: Hearing screening enormously increases the number of early-detected children. However, in quite a few screened children hearing loss is neither confirmed within three months after birth, nor intervened for within six months after birth. Reasons for the delay must be paid attention in order to warrant that UNHS can be as effective as possible.

[Evaluation of the Austrian Newborn Hearing Screening Program]. / Zehn Jahre Neugeborenen-Hörscreening in Osterreich. Eine Evaluierung.

BACKGROUND: Universal Neonatal Hearing Screening (UNHS) has been gradually implemented since the mid-nineties in Austrian maternity wards and neonatal intensive care units. This study evaluated the effect of UNHS on reducing age at identification as well as age of intervention for children with congenital and perinatal sensorineural hearing impairment. METHODS: This was a retrospective analysis of clinical data of 394 Austrian children diagnosed with an at least mild degree (> 20 dB hearing level) of permanent sensorineural hearing loss. Age at identification and age at intervention were compared between children who underwent UNHS ('with UNHS') and those who did not undergo UNHS ('without UNHS'). RESULTS: The median of age of identification was 37.6 months in children without UNHS, and 3.9 months in children with UNHS. By six months of age, 69% of hearing-impaired children who underwent UNHS, were identified but only 6% of those without UNHS. At one year, the corresponding percentages are 80% and 12%, respectively. In children without UNHS, the degree of hearing loss was the most predictive factor of age at identification (median of age at diagnosis for profound hearing loss: 15 months; severe: 26 months; moderate: 52 months; mild: 73 months). In children with UNHS, age of identification was unrelated to degree of hearing loss (medians between 3.7 and 4.4 months). In the majority of children intervention began within one month after diagnosis, regardless of whether or not the child was identified by UNHS. DISCUSSION: UNHS greatly increases the proportion of children whose hearing impairment is diagnosed before six months of age. However, in some 20% of children, hearing impairment was diagnosed later than one year of age, despite having failed the screening. Additionally, data from this study suggest that about 15% of childhood hearing losses manifest themselves after the hearing screening period. Efforts are thus required for the early detection of these children as well.

[Hearing screening at nursery schools: results of an evaluation study]. / Hörscreening an Kindergärten: Ergebnisse einer Evaluierungsstudie.

OBJECTIVE: This study aimed to evaluate the hearing screening of pre-school children at nursery schools in Tyrol, Austria. METHODS AND SAMPLE: 47 nursery schools with a total of 2199 enrolled children participated in the study. At the screening, the children were presented a series of tones at frequencies 0.5 kHz (25dB), 1 kHz, 2 kHz, 3 kHz, and 4 kHz (20 dB each) from portable audiometers. The tones were presented over headphones for each ear separately and at irregular intervals. Failure to respond to any of the frequencies was considered failure of the screening. Parents were then advised in written form to have the child examined by an ENT-specialist. RESULTS: 1832 individuals were screened (coverage: 83% of nursery school children; corresponding to at least 63% of all Tyrolean children aged 3 to 5 years). Of these, 390 failed the test (referral rate: 21% of all screened). Examination through an ENT-specialist occurred with 217 children, and this confirmed the positive test in 139 children (hit rate: 64%). In most cases, a temporary conductive hearing loss due to external or middle ear problems (glue ear, tube dysfunction, cerumen, otitis media) was diagnosed. A sensorineural hearing loss was found in 4 children (in 3 of them bilateral). The need for therapy was recognized in 81 children (4% of all screened). CONCLUSION: Pre-school hearing screening identifies children with ear and hearing problems that need therapeutical intervention. Although the hearing problems are mostly of a temporary nature, some may require monitoring over some period. Also some children with permanent sensorineural hearing loss may be detected through this measure. Hearing screening is an efficient means of assessing ear and hearing problems in pre-school children. However, the follow-up rate needs to be improved for optimizing the efficacy.

Analysis of ceiling effects occurring with speech recognition tests in adult cochlear-implanted patients.

This article presents a simple method of analysing speech test scores which are biased through ceiling effects. Eighty postlingually deafened adults implanted with a MED-EL COMBI 40/40+ cochlear implant (CI) were administered a numbers test and a sentence test at initial device activation and at 1, 3, 6, 12 and 24 months thereafter. As a measure for speech recognition performance, the number of patients who scored at the 'ceiling level' (i.e. at least 95% correct answers) was counted at each test interval. Results showed a quick increase in this number soon after device activation as well as a continuous improvement over time (numbers test: 1 month: 51%; 6 months: 73%; 24 months: 88%; sentence test: 1 month: 33%; 6 months: 49%; 24 months: 64%). The new method allows for the detection of speech recognition progress in CI patient samples even at late test intervals, where improvement curves based on averaged scores are usually assuming a flat shape.

Validation of three adaptations of the Meaningful Auditory Integration Scale (MAIS) to German, English and Polish.

The Meaningful Auditory Integration Scale (MAIS) is a parent-report questionnaire for assessing auditory behaviour in aurally habilitated children. This study addressed the reliability and convergent validity of three different language versions of the MAIS: English, German, and Polish. In total, 114 parents (English, n = 27: Polish, n = 37; German, n = 50) completed the MAIS preoperatively and at 6 months after cochlear implantation. Internal reliability (Cronbach's alpha) ranged from 0.92 to 0.95 preoperatively, and from 0.87 to 0.93 at 6 months. Split-half reliability was at least 0.90 preoperatively, and ranged from 0.76 to 0.89 at 6 months. Corrected item-total correlation coefficients were significant (p < 0.05) for all items except for item 1, which showed poor correlations in the Polish version. Correlation of the MAIS with the Listening Progress Profile (LP), as a measure for convergent validity, yielded coefficients between 0.81 and 0.73 preoperatively, and between 0.79 and 0.61 at 6 months. These findings demonstrate high reliability and convergent validity of the three MAIS versions.

Cochlear implantation in children under the age of two--what do the outcomes show us?

OBJECTIVES: Literature that discusses the benefits of cochlear implantation (CI) in children under the age of two is limited. Previous concerns about surgical risk have been raised and addressed; however, actual benefit in terms of outcomes needs to be clearly defined. This study evaluates outcomes of children implanted under the age of two and compares them to children implanted at a later age. METHODS: Data were reviewed from the MED-EL International Children's study database. Thirty-seven children enrolled in the study have received cochlear implants before the age of two. Outcomes were assessed using the LiP and MTP tests and the MAIS and MUSS questionnaires pre-operatively and then at initial fitting, 1, 3, 6 and 12 months after first fitting and then annually thereafter. RESULTS: Statistical analysis demonstrated that these children's scores improved significantly over time. Improvement was shown to occur at a quicker rate than for children implanted at an older age with the MTP and MUSS, but not with the LiP and the MAIS. Scores may be limited by sample size and the fact that children reached ceiling on some tests. CONCLUSIONS: Results suggest a distinct advantage early implantation may have for severe to profoundly hearing impaired children. This may be particularly the case for skills necessary for development of receptive and expressive language skills.