Cochlear Implants International An Interdisciplinary Journal
ISSN: 1467-0100 (Print) 1754-7628 (Online) Journal homepage: http://www.tandfonline.com/loi/ycii20
Cochlear implantation in adolescents: Factors influencing compliance Anne L Markey, Jaya Nichani, Morag Lockley, Christine Melling, Richard T Ramsden, Kevin MJ Green & Iain A Bruce To cite this article: Anne L Markey, Jaya Nichani, Morag Lockley, Christine Melling, Richard T Ramsden, Kevin MJ Green & Iain A Bruce (2015) Cochlear implantation in adolescents: Factors influencing compliance, Cochlear Implants International, 16:4, 186-194, DOI: 10.1179/1754762813Y.0000000033 To link to this article: http://dx.doi.org/10.1179/1754762813Y.0000000033
Published online: 14 Mar 2014.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ycii20 Download by: [University of Saskatchewan Library]
Date: 01 April 2016, At: 00:22
Original research paper
Cochlear implantation in adolescents: Factors influencing compliance Anne L Markey1, Jaya Nichani 1, Morag Lockley1, Christine Melling 1, Richard T Ramsden1, Kevin MJ Green 1,2, Iain A Bruce 1,2 1
Manchester Auditory Implant Centre, The University of Manchester, Manchester, UK, 2Manchester Academic Health Sciences Centre, Central Manchester NHS Foundation Trust, University of Manchester, Manchester, UK
Downloaded by [University of Saskatchewan Library] at 00:22 01 April 2016
Objectives: To quantify rates of non- and partial-use of cochlear implants (CIs) in adolescent patients implanted in adolescence and childhood and identify factors influencing compliance. Methods: A retrospective case note review undertaken at The Manchester Auditory Implant Centre. Adolescents were defined as young people aged 11–18 years. Individuals implanted in adolescence were defined as Group 1, individuals implanted in childhood under the age of 3 years and currently adolescents were defined as Group 2 and individuals implanted between the age of 3 and11 years and currently adolescents were defined as Group 3. Non-use was defined as not using the CI at all and partial use was defined as consistently using the CI less than full-time, or fluctuating periods of full and less than full-time use. Results: In Group 1 there was 1 non-user (1.3%) and 11 partial-users (13.9%), with an overall non-compliance rate of 15.2%. In Group 2 there was one non-user (1.9%) and one partial-user (1.9%) with an overall noncompliance rate of 3.8%. In Group 3 there were no non-users and eight partial-users (9%), with an overall non-compliance rate of 9%. The factors influencing compliance differed between groups with the most common factor in Group 1 being a preference for the auditory input gained from the contralateral hearing aid (50%). In Groups 2 and 3 the main factors influencing compliance were behavioural and related to wearing the implant only at school (50 and 75%, respectively). Conclusions: Patients implanted during adolescence have higher rates of non- and partial-use compared with their adolescent counterparts who have been implanted during childhood. It is important to investigate factors influencing non-compliance so appropriate support may be provided to the patient and their family. Keywords: Cochlear Implant, Non-use, Adolescent
Introduction In much of the available literature relating to cochlear implantation, adolescents are either grouped with children or not differentiated from adults (Ray et al., 2006; West and Stucky, 1995; Wheeler et al., 2007; Kelsay and Tyler, 1996). Yet adolescence is of developmental significance in its own right. It is a time when young people typically explore their identities; cope with rapidly changing body image and experience new emotional states. Adolescents are also highly diverse and while it is convenient to define adolescence as 11–18 years of age, the age span encompasses a very wide spectrum of maturity. In the literature, there is limited but conflicting evidence regarding non-compliance rates in adolescence with reported rates varying from 7.4 to 40% (Zeitler et al., 2012; Chute, 1993). Wheeler et al. (2007) Correspondence to: Anne Markey, Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. Email: [email protected]
186
© W. S. Maney & Son Ltd 2015 DOI 10.1179/1754762813Y.0000000033
reported a 6.9% partial-use rate in adolescents who had been implanted as children. However, rates of cochlear implant (CI) non- and partial-use are lower when all age groups (adults, adolescents, and children) are considered together (range from 2.82 to 4%) compared with adolescents considered in isolation (Chute, 1993; Ray et al., 2006; West and Stucky, 1995). Furthermore, when adolescents and children have been considered together non-use rates vary from 0 to 8% (Wheeler et al., 2007; Kelsay and Tyler, 1996). Non-use of a CI is an unsatisfactory outcome for the CI team and for the adolescent and his or her family. Additionally, there is a financial implication from nonuse and significant time resources are invested. In the UK, the current tariff for a CI is approximately £25 000, with yearly maintenance costs of £1000 and 5 yearly upgrade cost of £5000. It has been reported that in adults the cost of non-use increased the cost of a successful user by 5–10% (Summerfield and Marshall, 2000). It is important to investigate factors
Cochlear Implants International
2015
VOL.
16
NO.
4
Markey et al.
influencing non-compliance so that expectations are realistic and appropriate support for the patient and their family is made available. The aim of this study was to quantify and compare rates of non- and partial-use in adolescent patients who were implanted in adolescence with those implanted in childhood, and to identify factors influencing compliance.
Downloaded by [University of Saskatchewan Library] at 00:22 01 April 2016
Methods Patients were identified from the Manchester Auditory Implant Centre adolescent CI database. All patients had their CI surgery at the Manchester Auditory Implant Centre. Devices from three major CI manufacturers were available to use (Advanced Bionics, Valencia, United States of America; Med-El Corporation, Innsbruck, Austria; Cochlear Corporation, Australia). Adolescents were defined as children aged 11–18 years. The study group was subdivided into three groups. Group 1 comprised those patients implanted during adolescence and included patients who were now in the adult program. Group 2 included all the patients in the adolescent program who were implanted under the age of 3 years. Group 3 comprised those patients currently in the adolescent program that had been implanted between the ages of 3 and 11 years. A retrospective case note review was undertaken for each case of non- and partial-use between the years 1996–2011. Information was collected regarding age at surgery, duration of implantation, usage patterns, current use, and reasons for partial- and non-use. Where available, information was collected relating to the decision to undergo implantation and personal circumstances at the time of the implant that may have affected future usage of the implant. Those patients who never use their CI were classified as non-users and those who consistently use their CI less than full-time, or have fluctuating periods of full and less than full-time use were classified as partialusers. CI recipients within 1 year of implantation were excluded from the study.
Results Seventy-nine patients were implanted as adolescents (Group 1), of whom 39 are currently aged 11–18
Cochlear implantation in adolescents
years and 40 are now regarded as adults. One hundred and forty-one current adolescents were implanted in childhood. Of these 52 were implanted in the prelingual period (
ISSN: 1467-0100 (Print) 1754-7628 (Online) Journal homepage: http://www.tandfonline.com/loi/ycii20
Cochlear implantation in adolescents: Factors influencing compliance Anne L Markey, Jaya Nichani, Morag Lockley, Christine Melling, Richard T Ramsden, Kevin MJ Green & Iain A Bruce To cite this article: Anne L Markey, Jaya Nichani, Morag Lockley, Christine Melling, Richard T Ramsden, Kevin MJ Green & Iain A Bruce (2015) Cochlear implantation in adolescents: Factors influencing compliance, Cochlear Implants International, 16:4, 186-194, DOI: 10.1179/1754762813Y.0000000033 To link to this article: http://dx.doi.org/10.1179/1754762813Y.0000000033
Published online: 14 Mar 2014.
Submit your article to this journal
Article views: 83
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ycii20 Download by: [University of Saskatchewan Library]
Date: 01 April 2016, At: 00:22
Original research paper
Cochlear implantation in adolescents: Factors influencing compliance Anne L Markey1, Jaya Nichani 1, Morag Lockley1, Christine Melling 1, Richard T Ramsden1, Kevin MJ Green 1,2, Iain A Bruce 1,2 1
Manchester Auditory Implant Centre, The University of Manchester, Manchester, UK, 2Manchester Academic Health Sciences Centre, Central Manchester NHS Foundation Trust, University of Manchester, Manchester, UK
Downloaded by [University of Saskatchewan Library] at 00:22 01 April 2016
Objectives: To quantify rates of non- and partial-use of cochlear implants (CIs) in adolescent patients implanted in adolescence and childhood and identify factors influencing compliance. Methods: A retrospective case note review undertaken at The Manchester Auditory Implant Centre. Adolescents were defined as young people aged 11–18 years. Individuals implanted in adolescence were defined as Group 1, individuals implanted in childhood under the age of 3 years and currently adolescents were defined as Group 2 and individuals implanted between the age of 3 and11 years and currently adolescents were defined as Group 3. Non-use was defined as not using the CI at all and partial use was defined as consistently using the CI less than full-time, or fluctuating periods of full and less than full-time use. Results: In Group 1 there was 1 non-user (1.3%) and 11 partial-users (13.9%), with an overall non-compliance rate of 15.2%. In Group 2 there was one non-user (1.9%) and one partial-user (1.9%) with an overall noncompliance rate of 3.8%. In Group 3 there were no non-users and eight partial-users (9%), with an overall non-compliance rate of 9%. The factors influencing compliance differed between groups with the most common factor in Group 1 being a preference for the auditory input gained from the contralateral hearing aid (50%). In Groups 2 and 3 the main factors influencing compliance were behavioural and related to wearing the implant only at school (50 and 75%, respectively). Conclusions: Patients implanted during adolescence have higher rates of non- and partial-use compared with their adolescent counterparts who have been implanted during childhood. It is important to investigate factors influencing non-compliance so appropriate support may be provided to the patient and their family. Keywords: Cochlear Implant, Non-use, Adolescent
Introduction In much of the available literature relating to cochlear implantation, adolescents are either grouped with children or not differentiated from adults (Ray et al., 2006; West and Stucky, 1995; Wheeler et al., 2007; Kelsay and Tyler, 1996). Yet adolescence is of developmental significance in its own right. It is a time when young people typically explore their identities; cope with rapidly changing body image and experience new emotional states. Adolescents are also highly diverse and while it is convenient to define adolescence as 11–18 years of age, the age span encompasses a very wide spectrum of maturity. In the literature, there is limited but conflicting evidence regarding non-compliance rates in adolescence with reported rates varying from 7.4 to 40% (Zeitler et al., 2012; Chute, 1993). Wheeler et al. (2007) Correspondence to: Anne Markey, Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. Email: [email protected]
186
© W. S. Maney & Son Ltd 2015 DOI 10.1179/1754762813Y.0000000033
reported a 6.9% partial-use rate in adolescents who had been implanted as children. However, rates of cochlear implant (CI) non- and partial-use are lower when all age groups (adults, adolescents, and children) are considered together (range from 2.82 to 4%) compared with adolescents considered in isolation (Chute, 1993; Ray et al., 2006; West and Stucky, 1995). Furthermore, when adolescents and children have been considered together non-use rates vary from 0 to 8% (Wheeler et al., 2007; Kelsay and Tyler, 1996). Non-use of a CI is an unsatisfactory outcome for the CI team and for the adolescent and his or her family. Additionally, there is a financial implication from nonuse and significant time resources are invested. In the UK, the current tariff for a CI is approximately £25 000, with yearly maintenance costs of £1000 and 5 yearly upgrade cost of £5000. It has been reported that in adults the cost of non-use increased the cost of a successful user by 5–10% (Summerfield and Marshall, 2000). It is important to investigate factors
Cochlear Implants International
2015
VOL.
16
NO.
4
Markey et al.
influencing non-compliance so that expectations are realistic and appropriate support for the patient and their family is made available. The aim of this study was to quantify and compare rates of non- and partial-use in adolescent patients who were implanted in adolescence with those implanted in childhood, and to identify factors influencing compliance.
Downloaded by [University of Saskatchewan Library] at 00:22 01 April 2016
Methods Patients were identified from the Manchester Auditory Implant Centre adolescent CI database. All patients had their CI surgery at the Manchester Auditory Implant Centre. Devices from three major CI manufacturers were available to use (Advanced Bionics, Valencia, United States of America; Med-El Corporation, Innsbruck, Austria; Cochlear Corporation, Australia). Adolescents were defined as children aged 11–18 years. The study group was subdivided into three groups. Group 1 comprised those patients implanted during adolescence and included patients who were now in the adult program. Group 2 included all the patients in the adolescent program who were implanted under the age of 3 years. Group 3 comprised those patients currently in the adolescent program that had been implanted between the ages of 3 and 11 years. A retrospective case note review was undertaken for each case of non- and partial-use between the years 1996–2011. Information was collected regarding age at surgery, duration of implantation, usage patterns, current use, and reasons for partial- and non-use. Where available, information was collected relating to the decision to undergo implantation and personal circumstances at the time of the implant that may have affected future usage of the implant. Those patients who never use their CI were classified as non-users and those who consistently use their CI less than full-time, or have fluctuating periods of full and less than full-time use were classified as partialusers. CI recipients within 1 year of implantation were excluded from the study.
Results Seventy-nine patients were implanted as adolescents (Group 1), of whom 39 are currently aged 11–18
Cochlear implantation in adolescents
years and 40 are now regarded as adults. One hundred and forty-one current adolescents were implanted in childhood. Of these 52 were implanted in the prelingual period (
