Influencing variables in the quality of life of children with cochlear implants: a systematic review

Silva, Joice de Moura; Campos, Patricia Dominguez; Moret, Adriane Lima Mortari

doi:10.1590/2317-1782/20202019153

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Systematic Review • CoDAS 33 (1) • 2021 • https://doi.org/10.1590/2317-1782/20202019153 linkcopy

Influencing variables in the quality of life of children with cochlear implants: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To verify how the quality of life of children with cochlear implant was evaluated in published studies and to critically analyze which were the influencing variables.

Research Strategy Research guided by PRISMA recommendations. The guiding question was elaborated based on the PICO strategy, being: “Which variables are considered as influencers on the quality of life of children with cochlear implants?” The selected descriptors were cochlear implants, cochlear implants, quality of life, child and their synonyms, in the Portuguese, English and Spanish languages. We have identified indexed studies in the databases: Pubmed / MEDLINE, LILACS, Scopus, SciELO, Embase, EBSCO / CINAHL and Web of Science.

Selection Criteria Selected studies were selected, with levels of scientific evidence from 1 to 4, published in the Portuguese, English and Spanish languages, from 2009 to 2018. Data analysis: initially the titles of all the studies, followed by summaries and full reading of the most relevant texts.

Results After the rigorous analysis of the 1062 articles, eight were classified as containing the necessary answers to the guiding question of research. The selected studies were published between 2009 and 2016, classified as evidence level 2a and 4, with a sample of between 10 and 259 children and between the ages of 18 months and 18 years.

Conclusion The influencing factors that correlated with the quality of life of children with cochlear implants were early implantation, use of the electronic device, hearing skills and language skills.

Keywords
Quality of Life; Child; Hearing Loss; Cochlear Implantation; Review

Portuguese		English		Spanish
Descritores	Sinônimos	Descriptors	Synonyms	Descritores	Sinônimos
Implante Coclear	Implantação coclear	Cochlear implantation	Cochlear implantations	Implantación coclear	Implantación de prótesis coclear

	Implante de prótese coclear		Cochlear prosthesis

Implantes cocleares	-	Cochlear implants	Cochlear implant	Implantes cocleares	-

			Cochlear prostheses
Qualidade de vida	-	Quality of life	-	Calidad de vida	-
Criança	Crianças	Child	Children	Niño	-

				Niños

Data base	Search strategy	Number of articles selected
Pubmed/MEDLINE	(“cochlear implant” OR “cochlear implants” OR “cochlear prosthesis” OR “cochlear prostheses” OR “cochlear implantation” OR “cochlear implantations”) AND (“quality of life”) AND (“child” OR “children”)	212
LILACS	(“cochlear implant” OR “implante coclear” OR “implantación coclear” OR “cochlear implants” OR “implantes cocleares” OR “cochlear prosthesis” OR “implante de prótese coclear” OR “implantación de prótesis coclear” OR “cochlear prostheses” OR “cochlear implantation” OR “implantação coclear” OR “cochlear implantations”) AND (“quality of life” OR “qualidade de vida” OR “calidad de vida”) AND (“child” OR “criança” OR “niño” OR “children” OR “crianças” OR “niños”)	4
Scopus	(“cochlear implant” OR “cochlear implants” OR “cochlear prosthesis” OR “cochlear prostheses” OR “cochlear implantation” OR “cochlear implantations”) AND (“quality of life”) AND (“child” OR “children”)	275
SciELO	subject: (“cochlear implants” OR “cochlear implantation”) AND (“quality of life”) AND (“child” OR “children”)	6
Embase	(“cochlear implant” OR “cochlear implants” OR “cochlear prosthesis” OR “cochlear prostheses” OR “cochlear implantation” OR “cochlear implantations”) AND (“quality of life”) AND (“child” OR “children”)	263
EBSCO/CINAHL	(“cochlear implant” OR “cochlear implants” OR “cochlear prosthesis” OR “cochlear prostheses” OR “cochlear implantation” OR “cochlear implantations”) AND (“quality of life”) AND (“child” OR “children”)	77
Web of Science	(“cochlear implant” OR “cochlear implants” OR “cochlear prosthesis” OR “cochlear prostheses” OR “cochlear implantation” OR “cochlear implantations”) AND (“quality of life”) AND (“child” OR “children”)	225
Total	-	1062

Levels of evidence	Study types
1a	Systematic review or high-quality meta-analysis of randomized controlled trials
1b	High quality randomized controlled trials
2a	Systematic review or high-quality meta-analysis of non-randomized controlled trials
2b	High-quality, nonrandomized controlled trials
3a	Systematic review of cohort studies
3b	Individual cohort studies or low quality randomized controlled trials
4	Clinical outcome studies
5a	Systematic review of case control study
5b	Individual control case study
6	Case series
7	Expert opinion without explicit critical evaluation

Authors	Title	Level of evidence	Casuistry and age group	Objectives	Protocols used	Variables evaluated
Liu, Liu, Kang, Gu, Hong⁽²¹⁾	Evaluation on health-related quality of life in deaf children with cochlear implant in China	Level 4	259 children aged 48 months to 11 years and their parents	To assess changes in the quality of life of children and adolescents with unilateral CI using the HUI3 and NCIQ	Quality of life questionnaires: HUI3, NCIQ; Auditory speech perception test: MSP™	Hearing skills
Noble, Hedley-Williams, Sunderhaus, Dawant, Labadie, Camarata, Gifford⁽²²⁾	Initial results with image-guided cochlear implant programming in children	Level 4	18 children aged 5 to 17 years and their parents	Verify if image-guided CI programming can improve hearing results for children with CI	Quality of life questionnaire: PedsQL; Auditory speech perception test: LNT; CI programming: IGCIP	Hearing skills
Almeida, Matas, Couto, Carvalho⁽²³⁾	Quality of life evaluation in children with cochlear implants	Level 4	15 children aged 2 to 12 years and their respective parents	Assess the quality of life of 15 children after CI activation and analyze the possible correlations between the different domains of quality of life, the time of CI use and the development of hearing skills	Quality of life questionnaire: CCIPP; Auditory speech perception test: GASP and Scale of Hearing Categories	Demographic factor (hearing age) and hearing skills
Kumar, Warner-Czyz, Silver, Betty, Tobey⁽²⁴⁾	American parent perspectives on quality of life in pediatric cochlear implant recipients	Level 4	32 children aged 4 to 8 years and their parents	Assess the quality of life of children using CI and correlate with demographic variables	Quality of life questionnaire: CCIPP	Demographic factors (chronological age, age at activation and hearing age)
Morettin, Santos, Stefanini, Antonio, Bevilacqua, Cardoso⁽²⁵⁾	Measures of quality of life in children with cochlear implant: systematic review	Level 2a	Studies carried out with samples of 28 to 222 children aged 2 to 16 years and their respective parents	To identify studies on quality of life in children using cochlear implants, to survey the main aspects evaluated in this population and the factors related to the measurement of quality of life	Quality of life questionnaires: CCIPP, KINDL, EQ-5D, CIF, specific questionnaire for assessing the CI constructed by the authors and VAS	Demographic factors (age at surgery, chronological age, and hearing age), hearing skills and language skills
Fortunato-Tavares, Befi-Lopes, Bento, Andrade⁽²⁶⁾	Children with cochlear implants: communication skills and quality of life	Level 4	10 children aged 4 to 8 years and their parents	Translation and adaptation of an international questionnaire into Brazilian Portuguese; analysis of correlations between factors related to quality of life; analysis of the correlations between quality of life and clinical outcome measures	Quality of life questionnaire: CCIPP; Language questionnaires LAVE, MUSS; Auditory speech perception tests: MAIS, IT-MAIS	Auditory and language skills
Lovett, Kitterick, Hewitt, Summerfield⁽²⁷⁾	Bilateral or unilateral cochlear implantation for deaf children: an observational study	Level 4	106 children aged 18 months to 16 years and their parents	Assess whether bilateral implantation is associated with better listening skills and higher quality of life when compared to unilateral implantation	Quality of life questionnaires: HUI3, VAS; Auditory speech perception tests: Auditory location in silence and noise; SSQ	Hearing skills
Schorr, Roth, Fox⁽²⁸⁾	Quality of Life for children with cochlear implants: perceived benefits and problems and the perception of single words and emotional sounds	Level 4	37 children aged 5 to 14 years	Examine the subjective perceptions of children about the quality of life with the use of CI, to investigate the ability to perceive vocal emotion and the influence of auditory functioning and age in CI surgery on quality of life	Quality of life questionnaire: The QoL-C; Auditory speech perception tests: LNT, MLNT, Vocal emotion identification	Demographic factors (gender, socioeconomic status, chronological age, age at hearing aid fitting, age at CI activation and hearing age), hearing skills and language skills

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[1] Source: ASHA⁽¹⁹⁾.