Factors influencing rehabilitation and education in children who have cochlear implants: An integrative review

Abstract

Background: Several factors might impact the development of auditory, speech, and communication skills as well as academic performance in children with cochlear implants. These factors are important for these children’s transition to mainstream education. A lack of understanding among school staff about cochlear implant technology and these children’s special needs affects their school performance. Therefore, educational services need to include specialized sessions for nurses and teachers to meet the educational and special needs of these children.
Aim: To explore the factors influencing the rehabilitation and education of children who have cochlear implants and highlight empirical evidence that will guide the development of educational sessions for school nurses and teachers who encounter these students.
Methods: Whittemore and Knafl’s framework for integrative review guided this work. An electronic search was conducted using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Academic Search Complete databases. Data was extracted and organized into the individual, interpersonal and organizational, and policy and environmental levels of the Socio-Ecological Model.
Results: The individual-level factors are age at implantation, abnormal inner ear morphology, presence of additional disabilities, and hours of daily device use. The interpersonal and organizational factors include lower socioeconomic status, support within the family, and lack of experts at mainstream schools. The policy and environmental level factors are a failure in implementing hearing screening programs, lack of community awareness, and lack of clear education policies within the schools.
Conclusions: Children face challenges at schools due to a lack of experts who are familiar with the needs of children with cochlear implants. To realize the children’s needs and provide proper educational support by school staff, teaching and training sessions need to be.

Keywords

Cochlear implant / Children / Rehabilitation / Education / Schools

References

[1] World Health Organization.Global costs of unaddressed hearing loss and cost-effectiveness of interventions. 2017. Available from: https://apps.who.int/iris/handle/10665/254659

[2] Schmucker C, Kapp P, Motschall E, et al. Prevalence of hearing loss and use of hearing aids among children and adolescents in Germany: A systematic review. BMC Public Health. 2019; 19(1): 1277. PMid:31533687. https://doi.org/10.1186/s12889-019-7602-7

[3] Ebrahimi H, Mohammadi E, Mohammadi MA, et al. Stigma in mothers of deaf children. Iranian Journal of Otorhinolaryngology. 2015; 27(79): 109-118.

[4] LeClair KL, Saunders JE.Meeting the educational needs of children with hearing loss. Bulletin of the World Health Organization. 2019; 97(10): 722-724. PMid:31656339. https://doi.org/10.2471/BLT.18.227561

[5] Hughes ML. Receiving and maintaining a cochlear implant: What nurse life care planners need to know. Journal of Nurse Life Care Planning. 2012; 12(2): 618-630.

[6] Miller K. Cochlear implantation in Serbia: One center’s experienceinterview with Jovana Jeˇcmenica, Rade Kosanovi´c, Sandra Stojanovi ´c, Aleksandra Bajec-Opanˇcina, and Dragan Jeˇcmenica. Communication Disorders Quarterly. 2016; 37(4): 258-260. https://doi.org/10.1177/1525740115601854

[7] Cochlear.Hearing loss affects relationships in millions of families worldwide. 2019. Available from: https://www.cochlear.com/intl/about/media-centre/world-hearing-day-2019

[8] National Institute on Deafness and Other Communication Disorders.Cochlear implants. 2021. Available from: https://www.nidcd.nih.gov/sites/default/files/Documents/cochlear-implants.pdf

[9] Soman UG, Kan D, Tharpe AM. Rehabilitation and educational considerations for children with cochlear implants. Otolaryngologic Clinics of North America. 2012; 45(1): 141-153. PMid:22115687.https://doi.org/10.1016/j.otc.2011.08.022

[10] Magro I, Emmett SD, Saunders J. Cost-effectiveness of CI in developing countries. Current Opinion in Otolaryngology & Head & Neck Surgery. 2018; 26(3): 190-195. PMid:29528875. https://doi.org/10.1097/MOO.0000000000000451

[11] Whittemore R, Knafl K. The integrative review: Updated methodology. Journal of Advanced Nursing. 2005; 52(5): 546-553.PMid:16268861. https://doi.org/10.1111/j.1365-2648.2005.03621.x

[12] Golden SD, McLeroy KR, Green LW, et al. Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Education & Behaviour. 2015; 42(1): 8S-14S. PMid:25829123. https://doi.org/10.1177/1090198115575098

[13] Swami H, James E, Sabrigirish K, et al. A study to determine factors influencing outcomes of paediatric cochlear implants. Medical Journal Armed Forces India. 2013; 69(4): 366-368. PMid:24600145.https://doi.org/10.1016/j.mjafi.2012.10.008

[14] Fan X, Sui R, Qi X, et al. Analysis of the developmental trajectory and influencing factors of auditory and speech functions after cochlear implantation in Mandarin Chinese speaking children. Acta Oto-Laryngologica. 2020; 140(6): 501-508. PMid:32186221.https://doi.org/10.1080/00016489.2020.1736622

[15] Goh BS, Fadzilah N, Abdullah A, et al. Long-term outcomes of Universiti Kebangsaan Malaysia cochlear implant program among pediatric implantees. International Journal of Pediatric Otorhinolaryngology. 2018; 105: 27-32. PMid:29447813. https://doi.org/10.1016/j.ijporl.2017.11.024

[16] Nicastri M, Giallini I, Amicucci M, et al. Variables influencing executive functioning in preschool hearing-impaired children implanted within 24 months of age: An observational cohort study. European Archives of Oto-Rhino-Laryngology. 2020; 278(8): 2733-2743. PMid:32918140. https://doi.org/10.1007/s00405-020-06343-7

[17] Chu C, Dettman S, Choo D. Early intervention intensity and language outcomes for children using cochlear implants. Deafness & Education International. 2020; 22(2): 156-174. https://doi.org/10.1080/14643154.2019.1685755

[18] Bayguzina S, Yucel EE, Atas A. Determination the needs of the parents having children with cochlear implants during transition to pre-school institution. Journal of International Advanced Otology. 2012; 8(2): 253-270.

[19] Wang NM, Liu CJ, Liu SY, et al. Predicted factors related to auditory performance of school-aged children with cochlear implants. Cochlear Implants International: An Interdisciplinary Journal. 2011; 12(S1): S92-S95. PMid:21756485. https://doi.org/10.1179/146701011X13001035752615

[20] Noblitt B, Alfonso KP, Adkins M, et al. Barriers to rehabilitation care in pediatric cochlear implant recipients. Otology & Neurotology. 2018; 39(5): e307-e313. PMid:29649039. https://doi.org/10.1097/MAO.0000000000001777

[21] Saki N, Abshirini H, Bayat A, et al. Factors affecting age of diagnosis and rehabilitation intervention in children receiving cochlear implant. International Tinnitus Journal. 2018; 22(2): 123-127. https://doi.org/10.5935/0946-5448.20180021

[22] Sharma S, Bhatia K, Singh S, et al. Impact of socioeconomic factors on paediatric cochlear implant outcomes. International Journal of Pediatric Otorhinolaryngology. 2017; 102: 90-97. PMid:29106884.https://doi.org/10.1016/j.ijporl.2017.09.010

[23] Jeddi Z, Jafari Z, Zarandy MM. Effects of parents’ level of education and economic status on the age at cochlear implantation in children. Iranian Journal of Otorhinolaryngology. 2012; 24(66): 7-15.

[24] Yoshinaga-Itano C, Sedey AL, Wiggin M, et al. Language outcomes improved through early hearing detection and earlier cochlear implantation. Otology & Neurotology. 2018; 39(10): 1256-1263.PMid:30444842. https://doi.org/10.1097/MAO.0000000000001976

[25] Moroe N, Kathrada N. The long-term concerns post cochlear implantation as experienced by parents/caregivers of prelingually deaf children between the ages of 3 and 5 years in Gauteng Province, South Africa. South African Journal of Child Health. 2016; 10(2): 126-129.https://doi.org/10.7196/SAJCH.2016.v10i2.1049

[26] Olaniyan A, Isiguzo C, Hawk M. The Socioecological Model as a framework for exploring factors influencing childhood immunization uptake in Lagos state, Nigeria. BMC Public Health. 2021; 21(1):1-10. PMid:33952252. https://doi.org/10.1186/s12889-021-10922-6

[27] Black J, Hickson L, Black B, et al. Paediatric cochlear implantation: Adverse prognostic factors and trends from a review of 174 cases. Cochlear Implants International: An Interdisciplinary Journal. 2014; 15(2): 62-77. PMid:23998277. https://doi.org/10.1179/1754762813Y.0000000045

[28] Scarabello EM, Lamônica DAC, Morettin-Zupelari M, et al. Language evaluation in children with pre-lingual hearing loss and cochlear implant. Brazilian Journal of Otorhinolaryngology. 2020; 86(1): 91-98. PMid:30527397. https://doi.org/10.1016/j.bjorl.2018.10.006

[29] Choo OS, Kim H, Kim YJ, et al. Effect of age at cochlear implantation in educational placement and peer relationships. Ear & Hearing. 2021; 42(4): 1054-1061. PMid:33974787. https://doi.org/10.1097/AUD.0000000000001000

[30] Demir B, Cesur S, Sahin A, et al. Outcomes of cochlear implantation in children with inner ear malformations. European Archives of Oto-Rhino-Laryngology. 2019; 276(9): 2397-2403. PMid:31111254.https://doi.org/10.1007/s00405-019-05475-9

[31] Isaiah A, Lee D, Lenes-Voit F, et al. Clinical outcomes following cochlear implantation in children with inner ear anomalies. International Journal of Pediatric Otorhinolaryngology. 2017; 93: 1-6. PMid:28109477. https://doi.org/10.1016/j.ijporl.2016.12.001

[32] Shi Y, Li Y, Gong Y, et al. Cochlear implants for patients with inner ear malformation: Experience in a cohort of 877 surgeries. Clinical Otolaryngology. 2019; 44(4): 702-706. PMid:31062523. https://doi.org/10.1111/coa.13360

[33] Cupples L, Ching TY, Button L, et al. Spoken language and everyday functioning in 5-year-old children using hearing aids or cochlear implants. International Journal of Audiology. 2018; 57(sup2): S55-S69. PMid:28899200. https://doi.org/10.1080/14992027.2017.1370140

[34] de Jong T, van der Schroeff M, Vroegop J. Child-and environmentrelated factors influencing daily cochlear implant use: A datalog study. Ear and Hearing. 2021; 42(1): 122-129. PMid:32769438.https://doi.org/10.1097/AUD.0000000000000911

[35] Wiseman KB, Warner-Czyz AD, Kwon S, et al. Relationships between daily device use and early communication outcomes in young children with cochlear implants. Ear and Hearing. 2021; 42(4): 1042-1053. PMid:33974791. https://doi.org/10.1097/AUD.0000000000000999

[36] Contrera KJ, Choi JS, Blake CR, et al. Rates of long-term cochlear implant use in children. Otology and Neurotology. 2014; 35(3): 426-430. PMid:24518403. https://doi.org/10.1097/MAO.0000000000000243

[37] Panda S, Sikka K, Singh V, et al. Comprehensive analysis of factors leading to poor performance in prelingual cochlear implant recipients. Otology & Neurotology. 2019; 40(6): 754-760. PMid:31135664.https://doi.org/10.1097/MAO.0000000000002237

[38] Polat B, Ba¸saran B, Kara HÇ, et al. The impact of social and demographic features on comprehensive receptive and expressive performance in cochlear implant patients. The Turkish Journal of Ear,Nose, and Throat. 2013; 23(2): 90-95. PMid:23611322. https://doi.org/10.5606/kbbihtisas.2013.04378

[39] Yehudai N, Tzach N, Shpak T, et al. Demographic factors influencing educational placement of the hearing-impaired child with a cochlear implant. Otology & Neurotology. 2011; 32(6): 943-947. PMid:21512422. https://doi.org/10.1097/MAO.0b013e31821a8407

[40] Silva JDM, Yamada MO, Guedes EG, et al. Factors influencing the quality of life of children with cochlear implants. Brazilian Journal of Otorhinolaryngology. 2020; 86: 411-418. PMid:30898483.https://doi.org/10.1016/j.bjorl.2019.01.004

[41] Punch R, Hyde M. Rehabilitation efforts and stress in parents of children with cochlear implants. Australian & New Zealand Journal of Audiology. 2010; 32(1): 1-18. https://doi.org/10.1375/audi.32.1.1

[42] Vieira S. Dupas G, Chiari BM. Cochlear implant: The family’s perspective. Cochlear Implants International: An Interdisciplinary Journal. 2018; 19(4): 216-224. PMid:29363411. https://doi.org/10.1080/14670100.2018.1426406

[43] DesJardin JL, Ambrose SE, Eisenberg LS. Maternal involvement in the home literacy environment: Supporting literacy skills in children with cochlear implants. Communication Disorders Quarterly. 2011; 32(3): 135-150. https://doi.org/10.1177/1525740109340916

[44] Davenport CA, Holt RF. Influence of family environment on developmental outcomes in children with cochlear implants: A matched case study. The Volta Review. 2019; 119(1): 29-55. PMid:34113051. https://doi.org/10.17955/tvr.119.1.808

[45] Punch R, Hyde M. Children with cochlear implants in Australia:Educational settings, supports, and outcomes. Journal of Deaf Studies and Deaf Education. 2010; 15(4): 405-421. PMid:20525801.https://doi.org/10.1093/deafed/enq019

[46] Punch R, Hyde M. Social participation of children and adolescents with cochlear implants: A qualitative analysis of parent, teacher, and child interviews. Journal of Deaf Studies and Deaf Education. 2011; 16(4): 474-493. PMid:21372111. https://doi.org/10.1093/deafed/enr001

[47] Petrocchi-Bartal L, Khoza-Shangase K. Infant hearing screening at primary healthcare immunisation clinics in South Africa: The current status. South African Journal of Child Health. 2016; 10(2): 139-143.https://doi.org/10.7196/SAJCH.2016.v10i2.1114

[48] Cunningham M, Thomson V, McKiever E, et al. Infant, maternal, and hospital factors’ role in loss to follow-up after failed newborn hearing screening. Academic Pediatrics. 2018; 18(2): 188-195.PMid:28549746. https://doi.org/10.1016/j.acap.2017.05.005

[49] Alegre de la Rosa OM, Villar Angulo LM. Attitudes of children with hearing loss towards public inclusive education. Education Sciences. 2019; 9(3): 244. https://doi.org/10.3390/educsci9030244

[50] Davenport CA, Alber-Morgan SR. I have a child with a cochlear implant in my preschool classroom. Now what? Teaching Exceptional Children. 2016; 49(1): 41-48. https://doi.org/10.1177/0040059916651430