This research focused on the identification and description of predictors of pediatric and adult cochlear implantation outcomes in a South African cohort and the depiction of profound childhood hearing loss in terms of risk and intervention profiles. Study I described profound childhood hearing loss in a South African cohort of pediatric cochlear implant (CI) recipients in terms of risk profile and age of diagnosis and intervention. A retrospective review of patient files for 264 pediatric CI recipients from five CI programs was conducted. For all subjects, permanent congenital and early onset hearing loss (PCEHL) was confirmed under the age of five years old. The most prevalent risks for profound PCEHL were neonatal intesive care unit (NICU) admittance (28.1%), family history of childhood hearing loss (19.6%) and prematurity (15.1%). An associated syndrome was diagnosed in 10% of children and 23.5% had at least one additional developmental condition. Hearing loss for most (77.6%) children was confirmed as congenital or early onset, while 20.3% presented with postnatal onset of hearing loss. Auditory Neuropathy Spectrum Disorder (ANSD) was diagnosed in 5% of children, with admittance to NICU (80%) and hyperbilirubinemia (50%) being the most prevalent risk factors for these cases. Hearing loss was typically diagnosed late (15.3 months), resulting in delayed initial hearing aid fitting (18.8 months), enrollment in early intervention services (19.5 months), and eventual cochlear implantation (43.6 months). Delayed diagnosis and intervention predispose this population to poorer outcomes. / Thesis (DPhil)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / DPhil / Unrestricted

The objective of this study was to describe the influence of tinnitus distress on quality of life (QoL) outcomes in adult cochlear implant (CI) recipients who experience tinnitus, and to investigate the prognostic significance of tinnitus distress over time. A retrospective, longitudinal study of 210 adult (_18 years) CI recipients implanted between 2001 and 2017 was conducted. Data on hearing-related QoL, using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and tinnitus distress, using the Tinnitus Reaction Questionnaire (TRQ) were captured preoperatively as well as at 6-months, 12-months and >24-month postoperatively. The effect of tinnitus distress on hearing-related QoL outcomes over time was determined. Furthermore, 13 potential predictive factors were identified from the retrospective dataset, including demographic, hearing loss, CI, speech perception and tinnitus related factors. Multiple regression analyses were performed to identify variables that influence hearing-related QoL outcomes over time. Lower tinnitus distress and younger age at implantation were the only two out of 13 possible predictor variables that were identified as significant predictors of better hearing-related QoL in adult CI recipients. A general trend of statistically significant (p<0.01) tinnitus relief was evident from the preoperative interval to the 6-months, 12-months and >24-months postoperative intervals, confirming significant relief in tinnitus distress up to more than two years post-implantation. Within this dataset, higher levels of tinnitus distress were associated with poorer hearing-related QoL outcomes, as confirmed by the negative correlation between tinnitus distress and hearing-related QoL. This study contributes to a better understanding of the complex influence that multifactorial variables has upon the hearing-related QoL outcomes of adult CI recipients. This enables clinicians to provide evidence-based preoperative counselling combined with postoperative rehabilitation to adult CI recipients and their families. Not only was tinnitus distress confirmed as a predictive factor for hearing-related QoL in this study, but also the association between residual tinnitus distress and hearing-related QoL. These results emphasize the importance of identification, counselling and timely monitoring of adult CI recipients who experience tinnitus. / Dissertation (MA)--University of Pretoria, 2019. / Speech-Language Pathology and Audiology / MA / Unrestricted