Timing of Cochlear Implantation and Parents’ Global Ratings of Children’s Health and Development

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ObjectiveTo assess children’s health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories.Study DesignProspective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls.SettingSix US CI centers.PatientsDeaf children who received CI (n = 188) and hearing children of comparable ages (n = 97).InterventionCI before 5 years of age.Main Outcome MeasureParental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children’s growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning.ResultsBaseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development.ConclusionParental perspectives on quality of their child’s life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.

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