Authored by Rohit Mehrotra*
Abstract
Introduction: This retrospective study is based on assessment of outcome of cochlear implantation at Late Dr. Shiv Nath Mehrotra Charitable ENT foundation between 2016 to 2019 under ADIP(assistance to disable persons) scheme by taking into account various scoring systems like category of auditory performance (CAP), Speech intelligibility rating (SIR) and Glasgow children benefit inventory (GCBI).
Materials and methods: 300 children who were implanted between July 2016-March 2019 at Late. Dr. Shiv Nath Mehrotra Charitable ENT Foundation were included in the study. The results were analyzed using the above scoring system to assess the performance level and quality of life of each implanted children taking into consideration practical issues in Indian set up.
Results: 90% of total children implanted showed significant improved hearing, 80% with significant speech benefit and 90% with improved quality of life.
Conclusion: Outcome in terms of quality of life, auditory perception and rehabilitation was very good. The ADIP (assistance to disabled persons) scheme of central government has been a blessings for lower socio economic status children. Considerable improvement in hearing, speech and overall quality of life in almost 80% of children.
Keywords: Cochlear implantation; CAP score; SIR score; GCBI index; ADIP Scheme
Introduction
Over the last few years cochlear implantation has become the important treatment modality for children with severe to profound sensory neural hearing loss [1-4]. Inspite of dramatic improvement in cochlear implantation, various other factors decide the final result and outcome of implantation [5]. Variables affecting outcome of implant [6,7] are duration of disease, etiology of disease, age at onset of deafness, pre implant hearing aid use, communication mode, age at implantation [4], type of speech processor, duration of implant usage, family support and financial status, expertise provided, facilities for rehabilitation.
Problems unique to Indian scenarios of multi lingual society is of language barrier for rehabilitation. Well-equipped audiology unit with expertise team of audiologist are the basics for rehabilitation. Access to good schools for hearing challenged is the future way for good rehabilitation. Uniform rehabilitation in their mother tongue with active child’s parent participation are essentials for auditory verbal rehabilitation [8].
Developing habilitation methods in various regional languages is a daunting tasks for diverse Indian culture. Yet cochlear implantation program has grown exponentially.
The cochlear implantation program at Late Dr. Shiv Nath Mehrotra Charitable ENT Foundation, KANPUR under the ADIP scheme lays emphasis on after care and the extensive rehabilitation with a dedicated team of ENT surgeons, Audiologist, speech therapist, auditory verbal habilitationist and other staffs under one roof. The ADIP scheme (Assistance to disabled persons) was launched by Government of India under the leadership of our PM Shri Narendra Modi ji in 2014. It brought implantation and hearing to the lowest section of society who would never had the chance of hearing otherwise due to high costs. Under the ADIP scheme implant was procured by ALIMCO (Artificial Limbs Manufacturing Corporation of India) Kanpur. ALI YAVAR JUNG institute of speech and hearing Mumbai became the nodal authority to distribute the implant.
(Table 1) [9] Scales: CAP is a global outcome measure applied to assess the auditory receptive abilities of hearing impaired children. The Shepherd Centre’s revised version, based on Nottingham CI (cochlear implantation) Program, 1995.
(Table 2) [10, 11] SIR is a five point hierarchical scale globally used to measure the speech intelligibility of cochlear implantees.
GCBI (Glasgow Children Benefit Inventory)
This inventory was administered using the interview method. It consists of four domains with twenty-four items, which comprehensively assessed emotional, physical health, learning and vitality aspects of parents of children with a cochlear implant with five response levels „much better’, „a little better,’ no changes‟, „a little worse‟ and „much worse‟. Scoring the GCBI each question has a range of response – much better score +2, A little better score +1, neither or nor worse scores 0, A little worse scores -1 and much worse scores -2 Add up all scores for the 24 questions and divided by 24 and multiply by 50. This should give the responses on a scale from -100 (greatest possible harm) and +100 (greatest possible benefit).
Q.1 Has child operation made overall life better or worse.
Q.2 Has operation affected the things child does.
Q.3 Has operation made behaviour better or worse.
Q.4 Has operation affected progress and development.
Q.5 Has operation affected how lively the child during the day.
Q.6 Has operation affected how well child sleeps at night.
Q.7 Has operation affected enjoyment of food.
Q.8 Has operation affected how self-conscious with other people.
Q.9 Has operation affected how well child gets on with the rest of the family.
Q.10 Has operation affected the ability to spend time and have fun with friends.
Q.11 Has operation affected how embarrassed child feel with other people.
Q.12 Has operation affected how easily child gets distracted
Q.13 Has operation affected learning.
Q.14 Has operation affected the amount of time had to be off nursery, playgroup, or school?
Q.15 Has operation affected the ability to concentrate on the task?
Q.16 Has operation affected how frustrated and irritable child is
Q.17 Has operation affected how child feels about himself/ herself
Q.18 Has operation affected how happy and content child is
Q.19 Has operation affected child confidence
Q.20 Has operation affected the child self-care ability, such as washing, dressing, and using the toilet.
Q.21 Has operation affected the ability to enjoy leisure activities such as swimming, sports, and general play.
Q.22 Has operation affected how prone a child is to catch a cold and infections.
Q.23 Has operation affected how often child needs to visit a doctor.
Q.24 Has operation affected child needs for taking medication
Materials and Methods
Study was carried out at Late Dr Shiv Nath MEHROTRA Charitable ENT foundation KANPUR from July 2016 to March 2019. Out of 300 patients, 162 were male and 138 females. There were 5 Children in age group up to 1 year, 21 children in age group 1-2 year, 46 children in age group 2-3 years, 103 children in age group 3-4 years and 125 in age group 4-5 years. All patients received either digisonic or freedom cochlear implant.
Study was done by collecting data through fully completed clinical records and information regarding present performance of implantees from our team. The discussion also includes feedback from rehabilitation team about performance of each implantee, the duration at which patients attained speech abilities and reach the respective categories of CAP and SIR score and their GCBI index.
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