Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

Abstract

(1) Objectives: For full benefit in children implanted with a cochlear implant (CI), wearing the device all waking hours is necessary. This study focuses on the relationship between daily use and audiological outcomes, with the hypothesis that frequent daily device use coincides with high device satisfaction resulting in better functional gain (FG). Confounding factors such as implantation age, device experience and type of device were considered. (2) Results: Thirty-eight CI children (65 ears) were investigated. In total, 76.92% of the children were using their device for >12 h per day (h/d), 18.46% for 9−12 h/d, the remaining for 6−9 h/d and one subject reported 3 h/d. The revision rate up to the 90-month follow-up (F/U) was 4.6%. The mean FG was 59.00 ± 7.67 dB. The Audio Processor Satisfaction Questionnaire (APSQ) separated for single unit (SU) versus behind the ear (BTE) devices showed significantly better results for the latter in terms of wearing comfort (WC) (p = 0.00062). A correlation between device use and FG was found with a device experience of <2 years (n = 29; r2 = 0.398), whereas no correlation was seen with ≥2 years of device experience (n = 36; r2 = 0.0038). (3) Conclusion: This study found significant relationships between daily device use and FG, wearing comfort and long-term safety (90 months).

Keywords: audio processor satisfaction questionnaire (APSQ); cochlear implants; cumulative survival; device use; pediatric.

Figure 1

Soundfield audiometry. Displayed is the Soundfield audiometry showing the mean pre- and post-operative outcomes for two different follow-up (F/U) times: F/U1 (black dot): mean 1.30 ± 0.24 years; F/U2 (open square): 2.18 ± 1.31 years; separated regarding the age at implantation; full sign: age at implantation 3 years or older (≥3); open sign: age at implantation under 3 years of age (<3). The groups respective pre-operative values (unfilled symbols) are presented to show that subjects were within. The manufacturer’s indication limits are given as a light gray box, upper and lower indication limit in dB HL and * indicates upper limits in the x and y coordinates of up to 120 dB and up to 8 kHz.

Figure 2

Scatter plot correlation functional gain (FG) vs. daily device use. The scatter plots and the corresponding linear regression (full line) and its upper and lower confidence interval (dotted line) shows the correlation between the mean functional gain (FG) average and the daily device use in hours. In dark squares are the individuals with a device experience of less than two years (<2) and the gray open squares represent the children with a device experience of 2 years or more (≥2). The correlation coefficient r² was 0.3983 for the group <2 years (slight correlation) versus and r² of 0.00385 for the group of ≥2 years (no correlation).

Figure 3

Audio Processor Satisfaction Questionnaire (APSQ) as a function of device used. Boxplot shows the distribution of outcomes from the Audio Processor Satisfaction Questionnaire (APSQ) separated for the type of device used (SU (Single Unit) vs. BTE (Behind the Ear)) and split for the dimensions of “Wearing Comfort”, “Social Life”, “Usability” and the resulting “Total Score”.

Figure 4

Audio Processor Satisfaction Questionnaire (APSQ) as a function of follow-up (F/U). Scatter boxplot showing the dimension outcomes of the Audio Processor Satisfaction Questionnaire (APSQ) over time. F/U (Follow-up).

Figure 5

Kaplan–Meier survival analysis. Graph shows the Kaplan–Meier survival analysis calculating the ‘survival’ probability (A) for major complications over a course of 90 months. The survival proportion was extracted for each event shown in great bars and indicated by the arrow at the respective event time (months). Up until 36 months, the survival proportion lies at 96.92% and drops then for the remaining 54 months (total 90 months) to 90.0%. (B) The ‘survival’ probability for minor complications, split into medical-related conditions and external device problems (too strong a magnet). The survival proportion of the external device survival lies at 86.648%, whereas the survival proportion for the medical-related condition lies at 78.769%.