Development of a Cochlear Implantation Program in Malawi: Audiometric and Speech Perception Results From a Series of Implantees.

Abstract

Malawi performed its first cochlear implantation in 2014. Since then, the number of users has grown. This larger cohort facilitates a more rigorous analysis of the hearing outcomes that have been achieved by the Malawi cochlear implant (CI) program. Nineteen children with postlingual severe-to-profound deafness underwent unilateral cochlear implantation between 2014 and 2022. Pure-tone audiometric (PTA) thresholds were obtained for both ears preoperatively, and aided thresholds were determined for the implanted ear postoperatively. To assess hearing outcomes, a battery of open- and closed-set speech environmental sound perception tests were administered postoperatively. Observations related to the educational status of each participant were also documented. Cochlear implantation reduced the mean PTA4 threshold from 110.8 (range 96.3-120 dB hearing loss [HL]) to 37.8 dB HL (31.3-42.5 dB HL) in the implanted ear, improvements which were clinically meaningful and statistically significant (Wilcoxon signed-rank test: z = -3.184; P = .001). Satisfactory environmental and speech sound perception were observed for all tested CI users postimplantation. These results demonstrate that the CI program of Malawi can effectively treat severe-to-profound HL in postlingual children. However, several challenges remain for the expansion of this program.