Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants-not just cochlear implant-specific benefits-Perspective

Abstract

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8-9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Keywords: CI-specific risks; children and adolescents; cochlear implants; hearing loss; quality of life.

FIGURE 1

Image of a cochlear implant (with permission of Mauritius Images, Kd 55911). The external sound processor converts sound into a sequence of electrical impulses and sends these signals via a transmitter coil to the internal receiver-stimulator. The internal device, which is located under the skin in a cavity created in the skull bone, processes the electrical signal and transmits them via electrodes to the spiral ganglion cells of the cochlear nerve. Both internal and external devices are equipped with magnets.

FIGURE 2

Model illustrating CI-specific advantages and risks as possible influencing variables on QoL [following the model of Wilson and Cleary (1995)] of older children and adolescents with CI. Please note that this is a simplified illustration since possible associations and interactions between the variables are not shown and there is the assumption that the impact of variables can gain and lose weight over time. This possible dynamic was not illustrated in the graph; and individual characteristics, as well as socioeconomic and educational background, have also an impact on QoL but are not shown in the graph. Red: CI-specific benefit. Blue: Burden specific for hearing loss (Umansky et al., 2011; Rachakonda et al., 2014). Green: CI-specific risk.