Communicative and Hearing Performance in Individuals with Cochlear Implants and Delayed Neuropsychomotor Development: A Longitudinal Analysis

Rocha, Larissa Veloso; Zabeu-Fernandes, Julia Speranza; Brito Neto, Rubens Vuono de; Morettin-Zupelari, Marina; Lourençone, Luiz Fernando Manzoni

doi:10.1055/s-0042-1750765

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International Archives of Otorhinolaryngology

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Original Research • iao 27 (3) • Jul-Sep 2023 • https://doi.org/10.1055/s-0042-1750765 copy

Communicative and Hearing Performance in Individuals with Cochlear Implants and Delayed Neuropsychomotor Development: A Longitudinal Analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Between 15% to 30% of individuals with bilateral prelingual sensorineural hearing loss present with associated disabilities. Cochlear implant (CI) is an alternative treatment that provides consistent access to environmental and speech sounds, which results in significant benefits regarding quality of life and auditory and language development.

Objectives

To study the auditory and communicative performance of individuals with CI and delayed neuropsychomotor development after a minimum of five years using the device.

Methods

A total of eight patients were included in the study. We collected the multidisciplinary clinical records of participants, as well as the answers for the questionnaires applied remotely, which included the Children with Cochlear Implants: Parental Perspectives (CCIPP), International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY), and the Gross Motor Function Classification System (GMFCS).

Results

We found that throughout the years of CI use, the auditory threshold means improved significantly in all tested frequencies, as did the speech detection threshold and the language and hearing results. Regarding parental perception, parents evaluated aspects related to their children’s social relations to be positive, and had worse perceptions regarding aspects related to their education.

Conclusion

We observed a progression in the participants’ auditory and language skills throughout the years of CI use; even in the presence of other associated disabilities. Future multicentric studies with larger samples are needed to further the advancement of rehabilitation in patients with other associated disabilities.

Keywords
hearing loss; cochlear implantation; cerebral palsy; rehabilitation

Evaluation		Average	Minimum	Maximum	Standard deviation	p-value
	3 months	66.55	52.25	85.25	12.21
	6 months	82.92	57.50	92.50	12.79
Infant-Toddler Meaningful Auditory Integration Scale	1 year	90.71	77.50	100.00	10.18	0.0002
	2 years	90.00	60.00	100.00	14.65
	Last appointment	92.86	50.00	100.00	18.90
	3 months	10.50	2.50	17.50	5.42
	6 months	20.00	7.50	32.50	11.40
Meaningful Use of Speech Scale	1 year	30.00	10.00	72.50	22.36	< 0.001
	2 years	46.43	20.00	85.00	26.41
	Last appointment	57.50	0.00	100.00	50.58
	3 months	0.00	0.00	0.00	0.00
	6 months	0.00	0.00	0.00	0.00
Auditory recognition of phonemes (%)	1 year	0.00	0.00	0.00	0.00	0.0014
	2 years	21.56	0.00	90.00	39.98
	Last appointment	46.53	0.00	100.00	44.88
	3 months	0.00	0.00	0.00	0.00
	6 months	0.00	0.00	0.00	0.00
Auditory recognition of words (%)	1 year	0.00	0.00	0.00	0.00	0.0014
	2 years	14.38	0.00	75.00	28.21
	Last appointment	42.50	0.00	100.00	42.17
Sentences in silence	Last appointment	25.00	0.00	100.00	46.29	–
Sentences in noise with signal-to-noise ratio +10 dB	Last appointment	23.38	0.00	100.00	43.42	–

		Some degree of difficulty
Body functions	No disability n (%)	Mild disability n (%)	Moderate disability n (%)	Severe disability n (%)	Total disability n (%)
b110–State of consciousness	7 (87.50)	1 (12.50)	–	–	–
b114–Orientation functions	6 (75.00)	–	1 (12.50)	–	1 (12.50)
b117–Intellectual functions	1 (12.50)	3 (37.50)	1 (12.50)	2 (25.00)	1 (12.50)
b140–Attention functions	4 (50.00)	1 (12.50)	2 (25.00)	1 (12.50)	–
b144–Memory functions	4 (50.00)	1 (12.50)	2 (25.00)	1 (12.50)	–
b152–Emotional functions	7 (87.50)	1 (12.50)	–	–	–
b164–Higher-level cognitive functions	2 (25.00)	2 (25.00)	2 (25.00)	2 (25.00)	–
b167–Mental function of language	6 (75.00)	–	2 (25.00)	–	–
b210–Seeing functions	5 (62.50)	1 (12.50)	1 (12.50)	1 (12.50)	–
b230–Hearing functions	–	–	–	–	8 (100.00)
b235–Vestibular functions	2 (25.00)	4 (50.00)	1 (12.50)	–	1 (12.50)
b710–Mobility of joint functions	4 (50.00)	2 (25.00)	2 (25.00)	–	–
b730–Muscle power functions	6 (75.00)	1 (12.50)	1 (12.50)	–	–
b735–Muscle tone functions	4 (50.00)	3 (37.50)	–	–	1 (12.50)
b765–Involuntary movement functions	2 (25.00)	4 (50.00)	–	1 (12.50)	1 (12.50)
	Some degree of difficulty
Activities and participation	No difficulty n (%)	Slight difficulties n (%)	Moderate difficulties n (%)	Severe difficulties n (%)	Total difficulties n (%)
d110–Watching	4 (50.00)	–	1 (12.50)	1 (12.50)	2 (25.00)
d115–Listening	4 (50.00)	1 (12.50)	1 (12.50)	1 (12.50)	1 (12.50)
d140–Learning to read	2 (25.00)	–	2 (25.00)	1 (12.50)	3 (37.50)
d145–Learning to write	–	2 (25.00)	1 (12.50)	2 (25.00)	3 (37.50)
d150–Learning to calculate	1 (12.50)	1 (12.50)	1 (12.50)	1 (12.50)	4 (50.00)
d175–Solving problems	4 (50.00)	1 (12.50)	2 (25.00)	–	1 (12.50)
d210–Undertaking a single task	6 (75.00)	1 (12.50)	1 (12.50)	–	–
d220–Undertaking multiple tasks	6 (75.00)	–	–	–	2 (25.00)
d310–Communicating with - receiving - spoken messages	2 (25.00)	1 (12.50)	1 (12.50)	2 (25.00)	2 (25.00)
d315–Communicating with - receiving - nonverbal messages	5 (62.50)	1 (12.50)	2 (25.00)	–	–
d330–Speaking	3 (37.50)	1 (12.50)	2 (25.00)	2 (25.00)	–
d335–Producing nonverbal messages	6 (75.00)	1 (12.50)	1 (12.50)	1 (12.50)	–
d350–Conversation	5 (62.50)	1 (12.50)	–	1 (12.50)	1 (12.50)
d440–Fine hand use	3 (37.50)	1 (12.50)	3 (37.50)	1 (12.50)	–
d450–Walking	2 (25.00)	4 (50.00)	–	1 (12.50)	1 (12.50)
d465–Moving around using equipment	5 (62.50)	1 (12.50)	–	–	2 (25.00)
d510–Washing oneself	6 (75.00)	–	1 (12.50)	–	1 (12.50)
d520–Caring for body parts	4 (50.00)		2 (25.00)	1 (12.50)	1 (12.50)
d540–Dressing	5 (62.50)	2 (25.00)	–	1 (12.50)	–
d550–Eating	6 (75.00)	–	1 (12.50)	1 (12.50)	–
d560–Drinking	7 (87.50)	–	–	1 (12.50)	–
d710–Basic interpersonal interactions	6 (75.00)	–	–	2 (25.00)	–
d720–Complex interpersonal interactions	2 (25.00)	2 (25.00)	1 (12.50)	3 (37.50)	–
d760–Family relationships	7 (87.50)	–	–	1 (12.50)	–
d810–Informal education	6 (75.00)	–	1 (12.50)	–	1 (12.50)
d820–School education	2 (25.00)	–	2 (25.00)	2 (25.00)	2 (25.00)
d910–Community life	6 (75.00)	–	–	–	1 (12.50)

	Neither a barrier nor a facilitator n (%)	Barrier n (%)	Facilitator n (%)
e125–Products and technology for communication	2 (25.00)	1 (12.50)	5 (62.50)
e250–Sound	2 (25.00)	3 (37.50)	3 (37.50)
e310–Immediate family	3 (37.50)	1 (12.50)	4 (50.00)
e320–Friends	5 (62.50)	–	3 (37.50)
e580–Health services, systems, and policies	2 (25.00)	1 (12.50)	5 (62.50)

	Communication (CCIPP) p; rho	General functionality (CCIPP) p; rho	Self-confidence (CCIPP) p; rho	Wellbeing and happiness (CCIPP) p; rho	Social relationships (CCIPP) p; rho	Education (CCIPP) p; rho	Effects of CI (CCIPP) p; rho	Child support (CCIPP) p; rho	Activities and participation p; rho
Current age of the participant	–	–	–	–	–	–	–	0.0333; 0.7478	–
Use of CI in months (first surgery/activation)	–	–	–	0.0066; -0.8795	–	–	0.0167; -0.8263	–	0.0179; 0.8505
Thresholds for warble stimulus in free-field audiometry at the last appointment (dB)	–	–	–	–	–	0.0298; -0.7690	–	–	–
Thresholds for speech stimulus in free-field audiometry at the last appointment (dB)	–	–	–	–	0.0369; -0.7708	–	–	–	–
MUSS	0.0232; 0.8025	0.0071; 0.9000	–	–	–	0.0402; 0.7531	–	–	–
Auditory performance category	0.0103; 0.8589	0.0202; 0.8199	0.0157; 0.8221	–	–	0.0190; 0.8160	0.0095; 0.6587	0.0214; 0.5758	0.0238; -0.8399
Language category	0.0048; 0.9141	0.0006; 0.9690	–	–	–	0.0123; 0.8528	0.0532; 0.8607	–	–
Auditory recognition of phonemes (Delgado list)	0.0345; 0.7655	0.0039; 0.9250	–	–	–	0.0152; 0.8396	–	––	–
Auditory recognition of words (Delgado list)	0.0101 0.8643	0.0021; 0.9500	–	–	–	0.0080; 0.8766	–	–	–
Socioeconomic level	–	–	–	–	–	–	–	0.0429; -0.7329	–
Other associated disabilities	–	0.036; -0.775	–	–	–	–	–	–	–

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[1] Address for correspondence Julia Speranza Zabeu-Fernandes, PhD, Rua Silvio Marchione 3-20–Vila Nova Cidade Universitaria, 17012-900, Bauru, São Paulo–SP, Brazil (e-mail: julia.zabeu@usp.br).