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Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef, M.D., Ph.D. Consultant Audiovestibular medicine King Abdullah Ear Specialist Center (KAESC) King Saud University KSA CI2019 MIAMI, USA
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Page 1: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Auditory and language skills development after cochlear implantation in children with

multiple disabilities

Medhat Yousef, M.D., Ph.D.Consultant Audiovestibular medicine

King Abdullah Ear Specialist Center (KAESC)King Saud University

KSACI2019 MIAMI, USA

Page 2: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Background According to the 2018 report of WHO, hearing loss is

estimated to be the fourth leading cause of disability

globally that affects millions of people around the world.

It has been estimated that approximately 40-50% of

children with hearing loss have an additional medical or

developmental disability.

Page 3: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Background

• Physical disabilities• Developmental delay• Cerebral palsy • Attention deficit hyperactivity

• Learning disabilities• Visual impairment• Autism spectrum disorders• Mental retardation

Page 4: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Background Recently the candidacy criteria for pediatric cochlear

implantation are getting more flexible to include some hard of

hearing children with other disabilities and complex needs.

Although some studies investigated the quality of life issues in

cochlear-implanted children with other disabilities, few data are

available regarding the rehabilitation outcomes in terms of

auditory and verbal communication skills of those children.

Page 5: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Objectives

To investigate the outcomes of CI children with different co-

disabilities through using the Meaningful Auditory Integration

Scale (MAIS) and the Meaningful Use of Speech Scale

(MUSS) as outcome measurement tools.

Presenter
Presentation Notes
The main objective of this study is
Page 6: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Material & MethodsStudy Population

The study population comprised 2 groups:

1. The case group: 25 hearing-impaired children with co-disability who received cochlear implantation at our center.

2. The control group: Age and gender-matched controlgroup of 25 cochlear-implanted children without co-disabilities.

Presenter
Presentation Notes
This is a case–control study.
Page 7: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Material & MethodsStudy PopulationInclusion criteria for subjects in both groups:

1. All children should have pre-lingual severe to profoundsensorineural hearing loss and used a hearing aid for aperiod ranged between 3 to 6 months before surgery.

2. All children had used the CI and underwent rehabilitationfor at least 12 months using auditory-verbal therapy.

3. Documented diagnosis of at least one disability in additionto deafness.

Page 8: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Material & MethodsAuditory Skills Outcomes

Meaningful Auditory Integration Scale (MAIS)

• A 10-questions tool in which parents are asked to reportthe behavior and reactions of their children in using thecochlear implant device on throughout the day.

• Its maximum score is 40 points is obtainable under thescoring system.

• There are three divisions in scoring MAIS includingreliance on using the device, alerting to sounds, andderiving meaning from sound.

Page 9: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Material & MethodsLanguage and Speech Outcomes

Meaningful Use of Speech Scale (MUSS)

• A 10-item questionnaire in which the parents ratespeech abilities of their children on a scale from 0 to4 (highest).

• There are 3 divisions in scoring MUSS including thesound generation, the communication capability,and communication skills .

Page 10: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

ResultsThe disability group was subdivided according to the type of the disability into four subgroups:

1. Usher syndrome (N = 6).

2. Global Developmental Delay (GDD) (N = 6).

3. Autism Spectrum Disorder (ASD) (N = 9).

4. Attention Deficit Hyperactive Disorder (ADHD) (N = 4).

Page 11: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

ResultsCommunication Mode

Group Behavioral Oral Total

Usher 2 4 6ADHD 1 3 4GDD 4 2 6ASD 8 1 9

Control 1 24 25

Post-implantation, 15 out of 25 children in the case group made communication progress.

Presenter
Presentation Notes
All participants in were using behavior communication mode before cochlear implantation. Post-implantation, 15 out of 25 children in the case group made communication progress.
Page 12: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

I. Auditory Skills Outcomes

Groups Aided threshold MAISMean SD P Mean SD P

Usher (N=6)Control (N=25)

33.54 28.00

10.53 4.77

0.77 38.540.00

3.670.01

0.99

Developmental delay (N=9)

Control (N=25)

39.5828.00

15.50 4.77

0.11 23.8340.00

14.740.01

0.006

Autism (N=6)Control (N=25)

49.86 28.00

13.23 4.77

0.0001 18.8840.00

15.430.01

0.001

ADHD (N=4)Control (N=25)

33.68 28.00

1.02 4.77

0.85 24.7540.00

10.400.01

0.04

Total

Patients (N=25)Control (N=25)

40.89 28.00

3.58 4.77

0.0001 25.72 40.00

14.15 0.01

0.0001

Page 13: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

I. Auditory Skills Outcomes: There was a statistically significant difference between the patients and control groups

Groups Aided threshold MAISMean SD P Mean SD P

Usher (N=6)Control (N=25)

33.54 28.00

10.53 4.77

0.77 38.540.00

3.670.01

0.99

Developmental delay (N=9)

Control (N=25)

39.5828.00

15.50 4.77

0.11 23.8340.00

14.740.01

0.006

Autism (N=6)Control (N=25)

49.86 28.00

13.23 4.77

0.0001 18.8840.00

15.430.01

0.001

ADHD (N=4)Control (N=25)

33.68 28.00

1.02 4.77

0.85 24.7540.00

10.400.01

0.04

Total

Patients (N=25)Control (N=25)

40.89 28.00

3.58 4.77

0.0001 25.72 40.00

14.15 0.01

0.0001

Page 14: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

I. Auditory Skills Outcomes:Usher syndrome subgroup has obtained the best comparable auditory skills level as the control group.

Groups Aided threshold MAISMean SD P Mean SD P

Usher (N=6)Control (N=25)

33.54 28.00

10.53 4.77

0.77 38.540.00

3.670.01

0.99

Developmental delay (N=9)

Control (N=25)

39.5828.00

15.50 4.77

0.11 23.8340.00

14.740.01

0.006

Autism (N=6)Control (N=25)

49.86 28.00

13.23 4.77

0.0001 18.8840.00

15.430.01

0.001

ADHD (N=4)Control (N=25)

33.68 28.00

1.02 4.77

0.85 24.7540.00

10.400.01

0.04

Total

Patients (N=25)Control (N=25)

40.89 28.00

3.58 4.77

0.0001 25.72 40.00

14.15 0.01

0.0001

Page 15: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

I. Auditory Skills Outcomes:The autism spectrum disorder subgroup had the worst MAIS score.

Groups Aided threshold MAISMean SD P Mean SD P

Usher (N=6)Control (N=25)

33.54 28.00

10.53 4.77

0.77 38.540.00

3.670.01

0.99

Developmental delay (N=9)

Control (N=25)

39.5828.00

15.50 4.77

0.11 23.8340.00

14.740.01

0.006

Autism (N=6)Control (N=25)

49.86 28.00

13.23 4.77

0.0001 18.8840.00

15.430.01

0.001

ADHD (N=4)Control (N=25)

33.68 28.00

1.02 4.77

0.85 24.7540.00

10.400.01

0.04

Total

Patients (N=25)Control (N=25)

40.89 28.00

3.58 4.77

0.0001 25.72 40.00

14.15 0.01

0.0001

Page 16: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

II. Language and speech outcomes

Groups MUSSMean SD P

Usher (N=6)Control (N=25)

25.8329.88

11.037.61

0.88

Developmental delay (N=9)Control (N=25)

12.529.88

10.117.61

0.001

Autism (N=6)Control (N=25)

7.3329.88

7.567.61

0.0001

ADHD (N=4)Control (N=25)

10.529.88

4.437.61

0.003

Total

Patients (N=25)Control (N=25)

13.52 29.88

11.05 7.61 0.0001

Page 17: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

II. Language and speech outcomesA significantly statistical difference was obtained between the patients and control groups

Groups MUSSMean SD P

Usher (N=6)Control (N=25)

25.8329.88

11.037.61

0.88

Developmental delay (N=9)Control (N=25)

12.529.88

10.117.61

0.001

Autism (N=6)Control (N=25)

7.3329.88

7.567.61

0.0001

ADHD (N=4)Control (N=25)

10.529.88

4.437.61

0.003

Total

Patients (N=25)Control (N=25)

13.52 29.88

11.05 7.61 0.0001

Page 18: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

II. Language and speech outcomes: There was no statistical difference between the Usher syndrome subgroup and the control group

Groups MUSSMean SD P

Usher (N=6)Control (N=25)

25.8329.88

11.037.61

0.88

Developmental delay (N=9)Control (N=25)

12.529.88

10.117.61

0.001

Autism (N=6)Control (N=25)

7.3329.88

7.567.61

0.0001

ADHD (N=4)Control (N=25)

10.529.88

4.437.61

0.003

Total

Patients (N=25)Control (N=25)

13.52 29.88

11.05 7.61 0.0001

Page 19: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Summary & ConclusionHearing-impaired children with co-disabilities can demonstrate somebenefits from receiving CI including not only the auditory skills but alsothe communicative and language acquisition skills.

However, those benefits are limited and cannot be compared to the outcomes obtained in hearing-impaired children without additional disabilities.

Cochlear implantation decision for those group of children shouldbe cautiously considered and studied on an individual basis

according to the potential excepted benefits for each case.

Page 20: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

AcknowledgementTO all KAESC team specially:

Dr. Tamer Mesallam.

Miss. Ayna Almosaad

Page 21: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,
Page 22: Auditory and language skills development after cochlear ... · Auditory and language skills development after cochlear implantation in children with multiple disabilities Medhat Yousef,

Thank YouanY QuesTion?


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