Review of pediatric cochlear implantation records at the Tygerberg Hospital – Stellenbosch University Cochlear Implant Unit from 1990 – 2018

Lombaard, Suryn (2020-03)

Thesis (MAud)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT : The decision of parents of deaf children to proceed with cochlear implantation is often based on the expectation that the improved access to sound provided by the cochlear implant system will result in spoken language development that will improve the long-term educational development and occupational prospects of the child. These positive outcomes associated with pediatric cochlear implantation may result in financial benefits to society. A variety of factors may however determine the outcomes achieved. Cochlear implantation is an elective procedure and information about the expected outcomes and prognostic variables associated with outcome should be available to parents of candidates and funders to enable them to make informed decisions about their options. The main aim of the study was to describe the demographic and pre-operative clinical characteristics of pediatric cochlear implant recipients in the Tygerberg Hospital-Stellenbosch University Cochlear Implant Unit, the long-term post-operative trends in outcome in the domains of implant use, mode of communication, speech perception development, educational placement, occupational status and the variables associated with mainstream educational placement. The records of 216 recipients who received cochlear implants between 1990 and 2014 were reviewed. The recipients were grouped according to the age at onset of severe to profound sensorineural hearing loss: 0 to 2 years (n=166); > 2-5 years (n=17); >5 years (n=24) and Auditory Neuropathy Spectrum Disorder (n=9). Speech perception results recorded at annual visits were categorized in increasing order of difficulty in categories 0 to 7 (Dowell, Blamey & Clark, 1995). Implant use, mode of communication, educational placement during primary and secondary school and higher education were documented. The employment status of recipients was categorized according to the South African Standard Classification of Occupations (SASCO). Statistical analysis was performed to identify possible prognostic variables (age at onset and duration of deafness, age at implantation, co-morbidities, socio-economic status, maternal education, home language education and speech perception category) associated with mainstream educational placement. All the recipients who were implanted during childhood continued to use their devices. Ninety-six percent of the recipients (n=207) developed open-set speech perception and 95% (n=206) used oral language as mode of communication. In primary school, 39.4% of the recipients were placed in mainstream schools, while 91.3% were able to follow a mainstream curriculum. Forty-three percent of the recipients were in mainstream education during secondary school and 77% of the recipients were able to follow a mainstream curriculum. Fifty-four percent of the recipients who completed basic education were enrolled for or completed higher education and training. Seventy-three percent of the recipients seeking employment were employed. The average SASCO occupational skill level for these recipients was 2.4 (SD 0.96).The absence of a co-morbidity, maternal education level and speech perception category after two years of implant use, were independent variables associated with mainstream placement at primary and secondary school level. These findings are relevant for the parents of cochlear implant candidates, the funders of cochlear implant systems and clinicians.

AFRIKAANSE OPSOMMING : Die besluit van ouers van dowe kinders om voort te gaan met ‘n kogleêre inplanting berus dikwels op die verwagting dat die toegang tot klank wat die sisteem bied, die kind in staat sal stel om gesproke taal aan te leer, wat opvoedkundige ontwikkeling en loopbaanvooruitsige op die langtermyn sal verbeter. Hierdie positiewe uitkomste wat geassosieer word met pediatriese kogleêre inplantering, mag ook ‘n finansiële voordeel vir die gemeenskap inhou. ‘n Verskeidenheid van faktore mag egter bepaal watter uitkomste behaal word. Kogleêre inplantering is ‘n elektiewe prosedure en inligting rakende die verwagte uitkomste en prognostiese veranderlikes wat geassosieer word met uitkomste, moet beskikbaar wees vir ouers van kandidate en finasiële hulpbronne, ten einde hulle in staat te stel om ingeligte besluite te neem. Die doel van die studie was om die demografiese en pre-operatiewe kliniese eienskappe van ‘n groep pediatriese kogleêre inplanting ontvangers in die Tygerberg Hospitaal-Stellenbosch Universiteit Kogleêre Inplanting Eenheid, die langtermyn post-operatiewe uitkomste ten opsigte van inplanting gebruik, wyse van kommunikasie, spraakpersepsie ontwikkeling, opvoedkundige plasing, beroepe, asook die veranderlikes wat geassosieer is met hoofstroom opvoedkundige plasing, te beskryf. ‘n Rekordoorsig van 216 pediatriese ontvangers van kogleêre inplantings tussen 1990 en 2014, is uitgevoer. Die ontvangers is gegroepeer volgens ouderdom van aanvang van die erg tot uitermatige sensories-neurale gehoorverlies: 0 to 2 jaar (n=166); > 2-5 jaar (n=17); >5 jaar (n=24) en Ouditiewe Neuropatie Spektrum Afwyking (n=9). Spraakpersepsie resultate, soos bepaal tydens jaarlikse opvolge is gekategoriseer volgens die moeilikheidsgraad, in kategorieë 0 tot 7 (Dowell, Blamey & Clark, 1995). Die gebruik van die inplanting, wyse van kommunikasie en opvoedkundige plasing tydens basiese en hoër onderwys is gedokumenteer. Die beroepe van die ontvangers is gekategoriseer volgens die ‘Suid Afrikaanse Klassifikasie van Beroepe’ (SASCO). Statistiese berekeninge is uitgevoer, ten einde moontlike prognostiese veranderlikes te identifiseer (ouderdom van aanvang van doofheid en duur van doofheid, ouderdom van inplantering, verwante probleme, sosio-ekonomiese status, opvoedkundige kwalifikasie van moeder, moedertaalonderrig en spraakpersepsie kategorie) wat geassosieer kan word met hoofstroom opvoedkundige plasing. Al die ontvangers van kogleêre inplantings as kinders, was volgehoue gebruikers. Ses-en-negentig present van die ontvangers (n=207) was in staat om oopstel spraakpersepsie toetse te doen en vyf-en- negentig present was in staat om orale taal te gebruik as wyse van kommunikasie. Nege-en dertig present van die gebruikers het hoofstroom skole bygewoon in die laerskool, terwyl 91.3% toegang gehad het tot ‘n hoofstroom kurrikulum. Drie-en veertig present van die ontvangers het hoostroom skole in die hoërskool bygewoon en 77% het toegang gehad tot ‘n hoofstroom kurrikulim. Vier-en-vyftig present van die gebruikers wat basiese onderwys voltooi het, was besig of het reeds hoër onderrig voltooi. Drie-en- sewentig present van die gebruikers wat wou werk, het ‘n werk gehad. Die gemiddelde SASCO vaardigheids-vlak van hierdie gebruikers was 2.4 (SD 0.96).The afwesigheid van verwante probleme, opvoedkundige kwalifikasie van die moeder en die spraakpersepsie kategorie, twee jaar na inplantering, was onafhanklike veranderlikes wat geassosieer is met hoofstroom plasing. Die bevindinge van die studie is van belang vir ouers van kandidate, finansiële hulpbronne en professionele persone.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108080
This item appears in the following collections: