Long-term use of cochlear implant systems in paediatric recipients and factors contributing to non-use

The aim of the present paper was to assess children's long-term use of their cochlear implant systems and to explore factors influencing the extent of daily use. The parents of 138 deaf children who had been implanted for seven years completed an annual questionnaire about the extent of their child's use of their implant system. The results revealed that seven years after implantation 115 children (83%) were wearing their implants full-time, 16 (12%) most of the time, three (2%) some of the time and four (3%) were non-users. The children were categorised into those who were full-time users (group F) and those who were not full-time users (group N). The mean age at implantation in group F was 4.4 years with a median of four whereas in group N the mean age at implantation was 5.8 years with a median of 5.5 years. This difference was highly statistically significant. There were no children who were total non-users implanted below the age of five. The predominant mode of communication was oral in group F and signed communication in group N and the difference was also statistically significant. In group F, 90 (78%) were in mainstream education, either mainstream school or a resource base in a mainstream school, whereas the respective percentage in group N was 57 per cent and this difference was statistically significant. Further investigation of those in group N shows a fluctuating pattern of use over the years prior to becoming complete non-users seven years after implantation. The four children who were complete non-users at seven years after implantation were all implanted at five and had other difficulties with all having complex family issues, three having significant other learning difficulties and one experiencing pain on stimulation. None had experienced device failure. In conclusion, this study of 138 children showed very high levels of full-time use seven years after implantation. Factors linked with full-time use seven years after implantation were early implantation, oral mode of communication and mainstream educational placement. Additional difficulties were not significant. Psycho-social issues such as family and educational support appeared to be important in facilitating continued use of the implant system. Non-use may occur after several years of use and in this group non-use followed a fluctuating pattern of use over time. The regular monitoring of device use may enable cochlear implant teams to be alert to potential non-users and to provide appropriate and timely support to the child, family and educational service.