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Paediatric cochlear implantation: outcomes and current trends in education and rehabilitation
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124091.pdf (Publisher’s version ) (Open Access)Radboud Universiteit Nijmegen, 05 februari 2014Promotor : Snik, A.F.M. Co-promotores : Vermeulen, A.M., Archbold, S.M
Evidence of improving cost-effectiveness of pediatric cochlear implantation
No full textObjectives: to examine the cost-effectiveness of pediatric cochlear implantation over time.Methods: a prospective study based on ninety-eight children implanted between 1989 and 1996 at Nottingham's Paediatric Cochlear Implantation Programme, UK. The influence of outcomes and other variables on total costs was examined using multivariate regression analysis.Results: having controlled for potential confounding variables, total cost was negatively related to year of implant and positively related to the number of hours of rehabilitation (p=.000).Conclusions: having controlled for outcomes (Categories of Auditory Performance and Speech Intelligibility Rating), the cost-effectiveness improved over time. This finding may be due to a learning curve and have policy implications.</p
Variations in gains in auditory performance from pediatric cochlear implantation
No full textObjective: to investigate variations in gains in auditory performance in children with cochlear implants.Study design: the auditory performance of 98 children was measured with the Category of Auditory Performance survey instrument. All data were collected prospectively. Variables used to explain gain in Category of Auditory Performance were age at implantation, sex, the duration of "untreated" deafness, the year in which implantation occurred, health care inputs, and cause of hearing impairment. The data were analyzed by ordered probabilistic regression analysis.Results: gain in Category of Auditory Performance was observed to be negatively related to age at implantation, the year in which implantation took place, and the number of medical consultations the child received. None of the other variables were significant determinants of gain in Category of Auditory Performance.Conclusion: this study demonstrates the value of examining incremental gain from implantation rather than simply examining outcome levels. It was found that pediatric implantation is subject to diminishing returns. This suggests that further relaxation of entry criteria to implant programs should be undertaken only after careful consideration. The study also confirmed that age at implantation is an important determinant of outcomes. Greater gain in Category of Auditory Performance was experienced by those who underwent implantation at a younger age. This finding has implications for screening, as well as for purchasers and providers of implant services, highlighting the importance of responding in a timely fashion to identified need.</p
Willingness-to-pay for pediatric cochlear implantation
No full textObjective: this paper presents the results of the first willingness-to-pay (WTP) study to be undertaken on cochlear implantation. It aims to measure the values parents place on the UK having a pediatric cochlear implantation (PCI) programme.Methods: face-to-face semi-structured interviews were conducted with parents of children from the Nottingham Pediatric Cochlear Implant programme, whom had been implanted for a period ranging from 1 month to 13 years. Parents willingness-to-pay for the UK to have a pediatric cochlear implantation programme were elicited using a bidding process question format and via a discrete choice question. To see if income was a significant determinant of willingness-to-pay an analysis of variance (ANOVA) was undertaken in the statistical package SPSS version 10.Results: two hundred and sixteen parents were interviewed over the period July 2001-August 2002, representing over 130h of interviewing. The mean and median willingness-to-pay values elicited were UK pound 127 and 50 per month, respectively (UK pound 2001/2002). Willingness-to-pay was positively related to income (P<0.020). When the income constraint was removed, 99% of parents choose the implant over having the money the implant would cost to spend in some other way to benefit their child.Conclusions: parents of implanted children were willing to pay substantial monthly amounts for pediatric cochlear implantation. Most parents saw no alternative to pediatric cochlear implantation that could improve their child's quality of life to the same extent. Willingness-to-pay was sensitive to income as expected suggesting that the values elicited are both valid and influenced by a respondent's budget constraint.</p
The educational settings of profoundly deaf children with cochlear implants compared with age-matched peers with hearing aids: implications for management
No full textThe educational settings of 42 implanted profoundly deaf children 3 years after implantation were compared with the respective settings of 635 age-matched severely deaf and 511 profoundly deaf children with hearing aids. All implanted children received their implants before beginning school. The results revealed that 3 years after implantation. 38% (16 children) of the implanted profoundly deaf children attended mainstream schools, whereas 57% (24 children) were in a unit, or special class, in a mainstream school, and 5% (two children) were in schools for the deaf. With regard to the age-matched profoundly deaf children with hearing aids, 12% (63 children) attended mainstream schools, whereas 55% (281 children) were in a unit of a mainstream school, and 33% (167 children) were in schools for the deaf. In the group of age-matched severely deaf children, 38% (239 children) attended mainstream schools, whereas 51% (326 children) were in a unit of a mainstream school, and 11% (70 children) were in schools for the deaf. Statistical analysis revealed a highly significant difference between the educational placement of implanted children and hearing-aided profoundly deaf children (p<0.00001), whereas there was no statistically significant difference between implanted children and hearing-aided severely deaf children. In conclusion, implanted profoundly deaf children who have received their implants before beginning school have the same profile of educational placement as aided severely deaf children rather than aided profoundly deaf children of the same age in the UK. This is likely to have significant implications for the future management of profoundly deaf children and to influence future planning of educational support services
Parents' views on the quality of life of their children 2 to 3 years after cochlear implantation
No full textPaediatric cochlear implantation: evaluating outcomes
No full textThis book reviews published research concerning outcomes for deaf children with cochlear implants. The publications selected for review meet certain criteria - they were all published in English, they were published since 1994, and the number of children included in each study was at least 12. A thorough literature search was carried out yielding about 200 articles meeting these criteria. Paediatric Cochlear Implants considers a range of outcomes including use of audition by children, the development of language and quality of life. Advances in cochlear implantation that affect outcomes are also discussed.
The book offers critical summaries of relevant papers and an account of the conclusions of the research to date, highlights topics that have received less attention and suggests a framework for considering outcomes. It evaluates the strengths and weaknesses of current research with suggestion for possible future developments. This book will be of interest to all professionals and researchers concerned with deaf children, to parents of deaf children and to purchasers of healthcare services
Approach to communication, speech perception and intelligibility after paediatric cochlear implantation
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