Desenlaces comunicativos en niños con implante coclear y su relación con el coeficiente intelectual de su cuidador primario
Autor: Romero Moreno, Luis Felipe
Asesor: Echeverry Raad, Jairo (Thesis advisor)
Fecha: 2018-11-31
Programa: Bogotá - Medicina - Especialidad en Anestesiología y Reanimación
Facultad: Facultad de Medicina

Resumen: Objetivo:Evaluar  la  correlación  entre  el  coeficiente  intelectual  (CI)  del  cuidador  primario  y  los resultados  comunicativos en  niños  con  implante  coclear  (IC)  en  niños  sordos  pre  lingualescolombianos.Métodos:Se realizó un estudio analítico de observación transversal con pacientes con implante coclear unilateral entre 3 y 11 años. El tamaño de la muestra de 46 personas se calculó para detectar una correlación de 0,4, con un nivel de significación estadística de 0,05 y una potencia del 80% para correlacionar el coeficiente intelectual del cuidador primario, con la puntuación PLS-3 en el paciente. Se  excluyeron  los  pacientes  o  cuidadores  con  algún  grado  de  déficit  cognitivo  diagnosticado previamente, trastornos psiquiátricos, sordera poslingual e implante coclear bilateral. Resultados:Entre enero de 2016 y agosto de 201 se incluyeron 46 usuarios de IC. 19 hombres, 27 mujeres. Edad media a la implantación de 40 meses. La media del coeficiente de inteligencia primario del cuidador fue de 76,15, y la media del resultado en la prueba PLS-3 en pacientes fue de 25 meses. El resultado comunicativo se calculó midiendo la diferencia entre la edad auditiva esperada, menos la edad del lenguaje encontrada por PLS-3. Hubo una correlación inversa entre el rendimiento de CIen el cuidador principal y la diferencia en el resultado de PLS-3 respectivamente (rho de Spearman = -0,37, 푃ఀ=  0,0114).No  hubo  una  fuerte  correlación  entre  los  resultados  comunicativos  en  el paciente y el nivel socioeconómico del cuidador o el tipo de filiación de seguro de salud (chi2: 3,177. P = 0,3652, chi2: 0,95. P = 0,81). Conclusiones:La inteligencia de rendimiento en el cuidador principal, especialmente la cognición social / de memoria, se correlaciona con el resultado del habla postoperatoria en los usuarios de IC. Por lo tanto, la rehabilitación postoperatoria, incluido un programa domiciliario dirigido, podría ayudar a maximizar los resultados comunicativos postoperatorios.

Desenlaces comunicativos en niños con
implante coclear y su relación con el
coeficiente intelectual de su cuidador
primario
Luis Felipe Romero Moreno
Universidad Nacional de Colombia
Facultad de Medicina
Departamento de Cirugía
Unidad de Otorrinolaringología
Bogotá D.C, Colombia
2019Desenlaces comunicativos en niños con
implante coclear y su relación con el
coeficiente intelectual de su cuidador
primario
Luis Felipe Romero Moreno
Tesis o trabajo de investigación presentado como requisito parcial para optar al título de:
Otorrinolaringólogo
Director:
Dr Juan Carlos Izquierdo Velásquez
Otólogo y Neurotólogo
Universidad Nacional de Colombia
Facultad de Medicina
Departamento de Cirugía
Unidad de Otorrinolaringología
Bogotá D.C, Colombia
2019Contenido IV
Acknowledgement
The authors thank Dr. Juan Pablo Alzate Granados for help with statistical analysis. They also thank
Dr. Carlos Parra for his help in data collection in Cucuta city. Thanks to CINDA foundation Bogota,
Colombia for being open for health improvement in children’s with cochlear implant.Contenido 1
Desenlaces comunicativos en niños con implante coclear y su relación con el coeficiente
intelectual de su cuidador primario
Resumen
Objetivo: Evaluar la correlación entre el coeficiente intelectual (CI) del cuidador primario y los
resultados comunicativos en niños con implante coclear (IC) en niños sordos pre linguales
colombianos.
Métodos: Se realizó un estudio analítico de observación transversal con pacientes con implante
coclear unilateral entre 3 y 11 años. El tamaño de la muestra de 46 personas se calculó para detectar
una correlación de 0,4, con un nivel de significación estadística de 0,05 y una potencia del 80% para
correlacionar el coeficiente intelectual del cuidador primario, con la puntuación PLS-3 en el paciente.
Se excluyeron los pacientes o cuidadores con algún grado de déficit cognitivo diagnosticado
previamente, trastornos psiquiátricos, sordera poslingual e implante coclear bilateral.
Resultados: Entre enero de 2016 y agosto de 201 se incluyeron 46 usuarios de IC. 19 hombres, 27
mujeres. Edad media a la implantación de 40 meses. La media del coeficiente de inteligencia primario
del cuidador fue de 76,15, y la media del resultado en la prueba PLS-3 en pacientes fue de 25 meses.
El resultado comunicativo se calculó midiendo la diferencia entre la edad auditiva esperada, menos
la edad del lenguaje encontrada por PLS-3. Hubo una correlación inversa entre el rendimiento de CI
en el cuidador principal y la diferencia en el resultado de PLS-3 respectivamente (rho de Spearman
= -0,37, 𝑃  = 0,0114). No hubo una fuerte correlación entre los resultados comunicativos en el
paciente y el nivel socioeconómico del cuidador o el tipo de filiación de seguro de salud (chi2: 3,177.
P = 0,3652, chi2: 0,95. P = 0,81).
Conclusiones: La inteligencia de rendimiento en el cuidador principal, especialmente la cognición
social / de memoria, se correlaciona con el resultado del habla postoperatoria en los usuarios de IC.
Por lo tanto, la rehabilitación postoperatoria, incluido un programa domiciliario dirigido, podría ayudar
a maximizar los resultados comunicativos postoperatorios.
Palabras clave: Implante de Coclear, Coeficiente intelectual, desenlaces comunicativos, cuidador
primario.Contenido 2
The relationship between communicative skills in cochlear implant patients and the IQ score
of the primary caregiver.
Abstract
Objective: Assess the correlation between primary caregiver Intellectual Coefficient (IQ) and the
communicative outcomes in children with Cochlear implant (IQ) in Colombian pre lingual deaf
children.
Methods: An analytical, observational cross-sectional study was performed with patients with
unilateral cochlear implant between 3 and 11 years. Sample size of 46 people was calculated to
detect a correlation of 0.4, with a statistical significance level of 0.05 and a power of 80% to correlate
the IQ of the primary caregiver, with the PLS-3 score in the patient. Patients or caregivers with any
degree of cognitive deficit previously diagnosed, psychiatric disorders, post-lingual deafness and
bilateral cochlear implant were excluded.
Results: 46 CI users were included between January 2016 and August 2018. 19 males, 27 females.
Median age at implantation of 40 months. The mean average of primary caregiver IQ was 76,15, and
the average of result in PLS-3 test in patients was 25 months. The communicative outcome was
calculated measuring the difference between the expected auditive age , less found language age by
PLS-3. There was an inverse correlation between the IQ performance in the primary caregiver and
the difference in the PLS-3 result respectively (Spearman’s rho= -0,37, 𝑃 = 0,0114). There was no
a strong correlation between communicative outcomes in patient and socioeconomic level of the
caregiver or type of health insurance filiation (chi2: 3,177. p=0,3652, chi2:0.95. p=0,81).
Conclusions: Performance intelligence in the primary caregiver, especially social/memory cognition,
is correlated with the postoperative speech outcome in CI users. Therefore, postoperative
rehabilitation, including a directed home program—might help to maximize the postoperative
communicative outcomes.
Keywords: Choclear implant, IQ, communicative Outcomes, primary caregiverContenido 3
1. Introduction
The incidence of congenital sensorineural hearing loss (SNHL) oscillates about 1 per 650 live births
1, 2, 3. The late diagnosis of deafness and the incorrect patient rehabilitation represents a problem of
general interest with direct repercussions on the quality of life of individuals and their families as well
as a negative impact on the economy of a society4.
The placement of a cochlear implant (CI) at timely age does not guarantee the development of
appropriate communicative skills in the deaf patient 5, 6. It has been seen that communicative
outcomes in oral and written language differ between individuals implanted with similar characteristics
and disease contexts 7, 8. In this way, the primary caregiver of the patient with a cochlear implant plays
a fundamental role in the diagnosis, treatment, and rehabilitation of the deaf patient 9, 10.
Measuring the ability to solve problems, abstraction and perceptual reasoning in the child implanted
through an intellectual coefficient (IQ) test is a task that has been done previously 11, 12, 13. However,
to measure the IQ of the primary caregiver of the child with a CI has never been done before and the
authors strongly believe could provide relevant data for the otolaryngologist and audiologist in charge
about the process of hearing rehabilitation in the children.
The main objective of this study is to determine the relationship between communicative outcomes
in children with CI and the IQ of their primary caregiver as a predictor of success or failure in the
process of aditory rehabilitation and the development of verbal and communicative skills in a
developing country.
2. Materials and methods
An analytical, observational cross-sectional study was performed in patients with unilateral cochlear
implant between 3 and 11 years of age from different type of health insurance, including private
Otolaryngology consultation. The less time of auditory age for apply to the study was 2 years, and
rehabilitation auditive therapy access after the surgery was mandatory. The exclusion criteria included
any degree of cognitive deficit previously diagnosed (in patient or caregiver), any psychiatric disorders
(in patient or caregiver), post-lingual deafness and bilateral cochlear implant. We assessed the IQ of
the primary caregiver of the patient with cochlear implant using the Wechsler Adult Intelligence Scale
IV (WAIS-IV) that was correlated with the communicative outcomes in the child implanted with a
closed set of word recognition, validated for the Spanish language with the word identification test:
Preschool Language Scale (PLS-3)Contenido 4
We calculated a sample size of 47 people to detect a correlation of 0.4, with a statistical significance
level of 0.05 and a power of 80% to correlate the IQ of the primary caregiver of the child, with the
PLS-3 score. Data was stored in Microsoft Excel base data and processed in STATA 11.0. This study
was approved by the Institutional Review Committee of the Universidad Nacional de Colombia.
Parents or legal guardians signed a consent that explained the procedure and potential risks.
3. Results
The communicative outcome was measured by calculating the difference between the expected
hearing age in months, on the auditory age found by the PLS-3 test.
1. It shows 46 patients. Rho Spearman coefficient -0.37, Moderately negative relationship. P> 0.011.
Show graph
1.1. There is an inverse relationship between the IQ of the primary caregiver and the calculated
hearing age of the patient with a cochlear implant. Although it helps determine the outcome of
the language of the implanted patient, it is not a determinant in the final result.
Rho Spearman (-0,37)
P< 0,011
120
100
80
60
40
20
0
0 20 40 60 80 100
2. There is no correlation between the IQ result of the primary caregiver and the opportunity for
diagnosis and agility in the placement of the implant. Rho Spearman: 0.10 (p> 0.49).
3. When WAIS IV is compared to the result of PLS-3, without standardizing, the result is not
statistically significant. Rho Spearman: 0.21 (p> 0.15).
Table 1. Distribution of the population according to the scheme of affiliation to the General System of
social security in health:
RÉGIMEN N %
Contributive 33 71%Contenido 5
Subsidized 9 20%
SISBEN 1 2%
Special 3 6%
Total 46 100%
1. There is no significant difference between the speed of implant placement after diagnosis,
comparing them by affiliation regime.
1.1. There is a bias in the distribution of the sample, because 70% of the sample corresponds to the
contributory regime. Chi2: 5.35 (p 0.25)
Table 2. Distribution by diagnosis
Diagnóstico N % Percentage
Congenital hearing loss 34 78%
Early Neonatal Hypoxia 4 10%
Neonatal meningitis 2 4%
Ototoxicity by Antibiotics 1 2%
Sx Waardenburg 2 4%
Sx Usher 1 2%
Table 3. Distribution by city of origin
City N % Percentage
Bogotá 15 32%
Cúcuta 31 68%
Table 4. Distribution by kinship of the primary caregiver:Contenido 6
Primary caregiver N % Percentage
Mother 30 65%
Father 10 22%
Grandmother 5 11%
Grandfather 1 2%
Table 5. Sociodemographic variables
Variable Average SD Range
Chronological age (years) 8,08 3,83 3-11
Age of diagnosis (months) 23 10,5 3-48
Implant age (years) 3,34 1,23 1-6
Minutes of weekly therapy (min) 95,8 30 30 - 420
Expected hearing age (months) 58,93 44,9 6-216
Auditory age found (months) 25,95 20,97 4-84
PLS- corrected (months) 32,97 39,5 26-132
Table 6. Distribution according to the result of WAIS IV in the primary caregiver
Variable Average SD Range
WAIS IV 76,15 19,01 41-121
Verbal comprehension 75,91 21,6 35-127
perceptual reasoning 68,36 19,9 12-106
Work memory 72,02 23,9 7-121
Processing speed 70,58 24,0 1-107
3. There is no difference in time between diagnosis and implant placement, according to
socioeconomic status (chi2: 3,177, p = 0,3652)
3.1. There is also no difference between the difference in expected age and age found (corrected
hearing age) and the socioeconomic stratum (chi2: 0.95, p = 0.81)Contenido 7
4. There is no correlation between each of the domains of the WAIS IV test, with the corrected auditory
age of the patient. Verbal comprehension (-0.1342), Perceptual reasoning (-0.2195), Work memory
(-0.1592), Procedure speed (0.0712)
Discussion
There exist so many variables that have been recognized as predictors of success in children with
prelingual deafness who are taken to CI surgery. Age of diagnosis of deafness, age of CI placement
(children implanted early achieve better results - Anderson et al., 2004; Colleti et al., 2005); and
among these Miyamoto, et al in 2010 and Preisler in 2011, propose that the level of stimulation within
the family and access to basic health conditions are a fundamental component in the auditory and
language success in the implanted child.
It is hypothesized that the insertion of an implant and the consequent access to auditory information
should be followed by an increase in the number of different words used in the spontaneous play
interaction predetermined by the primary caregiver, these one must have the basics cognitive abilities
to ensure the adequate psychomotor and neuropsychological development in the patient with CI.
Nowadays the need for directed rehabilitation at home demands that therapist should focus
domiciliary work in such a way that facilitates their understanding and subsequent reproduction from
the primary caregiver, emphasizing their neurocognitive and motor strengths. It follows, then, a
different rehabilitation process, involving both parties actively, creating learning and teaching
programs of speech, in a directed and individual way.
To determine objectively the cognitive substrate of the guardian give us the tools to predict how
successful and agile can be the home rehabilitation in the child and how feasible is that the primary
caregiver provides the necessary stimuli for the development of oral and written language skills.
Although there are many variables that influence the success of the cochlear implant, the author
strongly believe that
The post-surgery period requires reorganization of the family’s social world. Family members, in order
to cope with the new demands that accompany implantation, have to assume new roles and adjust
household dynamics (Allegretti, 2002). We found, as the studies of Spahn et al. (2004) and Punch
and Hyde (2010) reported, that during the habilitation process mothers tend to leave their jobs in
order to become the main caregiver, while fathers become the economic provider. This role change
reflects the family need to adapt to the new social environment after surgery and their attempt to
maintain cohesionand unity to cope with the habilitation process.
To recognize the difficulties parents face when they cannot match their cognitive understanding of it
with their feelings and expectations. Understanding that cochlear implantation is a human experienceContenido 8
in which silence, stress, anguish, and solitude are factors that parents reported to have dealt with on
an everyday basis, helps us to view implantation as a bio-psychosocial reality that requires competent
and accurate communication levels between medical staff and families. How parents perceive
cochlear implantation is framed by the combination of individuals’ life trajectories and their socio-
cultural context, however this perspective needs further research. Consequently, it is important to
promote the creation of support groups that can work jointly with medical staff.
However the final outcome in paediatric implantation is yet not entirely predictable as there are a
large number of factors which alone or in combination will decide the outcome of cochlear
implantation.2,3 Categorizing these determinants increases the ability of clinicians to offer educated
preoperative prognosis and might potentially allow for manipulation of variables in an attempt to
achieve the best possible outcome
The cochlear implanted children showed improvement in their auditory skills in the first year of
cochlear implant device use. Most studies of paediatric cochlear implant surgery have focused on
assessing auditory skills and speech.6,7 In this study, we have evaluated the correlation of
performance measures of auditory skills by Meaningful Auditory Integration Scale and Speech by
Meaning use of Speech Scale measures done one to three years after Cochlear Implantation.
Conclusions
Performance intelligence in the primary caregiver, especially social/memory cognition, is correlated
with the postoperative speech outcome in CI users. Therefore, postoperative rehabilitation, including
a directed home program—might help to maximize the postoperative communicative outcomes.
Disclosure Statement
The authors have no conflicts of interest to declare
Funding Sources
Own resourcesContenido 9
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