title: Timing of cochlear implantation and parents' global ratings of children's health and development.
abstract: OBJECTIVE
  To assess children's health-related quality of life (HRQL) and development after cochlear implant (CI) surgery and compare improvements between different age of implantation categories.
  
  
  METHODS
  Prospective, longitudinal study comparing outcomes of deaf children post-CI with hearing controls.
  
  
  METHODS
  Six US CI centers.
  
  
  METHODS
  Deaf children who received CI (n = 188) and hearing children of comparable ages (n = 97).
  
  
  METHODS
  CI before 5 years of age.
  
  
  METHODS
  Parental ratings of global HRQL and development, as assessed over the first 4 years of follow-up using visual analog scales. Development scores assess parental views of children's growth and development, motor skills, ability to express themselves and communicate with others, and learning abilities. Associations of baseline child and family characteristics with post-CI HRQL and development were investigated using multivariable analysis, controlling for factors that influence post-CI language learning.
  
  
  RESULTS
  Baseline deficits of CI candidates relative to hearing controls were larger in development than HRQL. Development scores improved significantly by 4 years after CI, particularly in the youngest CI recipients. Developmental deficits of older CI recipients with early, extended hearing aid use were only partially remediated by CI. Overall, no significant health deficits were observed in CI children after 4 years. Cognition and speech recognition were positively associated with both HRQL and development.
  
  
  CONCLUSIONS
  Parental perspectives on quality of their child's life and development provide practical insight into the optimal timing of interventions for early-onset deafness. Validity of parental global assessments is supported by clinical measures of speech perception and language learning and comparison with a well-validated health status instrument.
authors.affiliation: Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Clark
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Anne W
authors.initials: AW
authors.lastname: Riley
authors.forename: Christine M
authors.initials: CM
authors.lastname: Carson
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Meserole
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lin
authors.forename: Laurie S
authors.initials: LS
authors.lastname: Eisenberg
authors.forename: Emily A
authors.initials: EA
authors.lastname: Tobey
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Quittner
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
mesh_terms: D002657:Child Development; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D003638:Deafness / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D007804:Language Development; D008137:Longitudinal Studies; D008297:Male; D010290:Parents; D011446:Prospective Studies; D011788:Quality of Life; D013067:Speech Perception; D013068:Speech Production Measurement; D016896:Treatment Outcome