Objective: To develop and implement a universal screening protocol for depression and anxiety in adolescents serviced in an otology and audiology practice and to estimate the prevalence of depression and anxiety in adolescents with hearing loss, while also comparing rates by degree of hearing loss and type of hearing device used. Study Design: Cross-sectional. Setting: University tertiary medical center. Patients: One hundred four adolescents 12- to 18-years-old who attended an otology clinic in a large metropolitan hospital in the southeastern United States. Main Outcome Measure: (s): Depression (PHQ-8), anxiety (GAD-7), degree of hearing loss, type of hearing loss, and type of hearing device utilized. Results: Twenty-five percent of adolescents scored above the clinical cutoff on at least one of the depression and/or anxiety measures, with 10% scoring in the elevated range on both measures. Specifically, 17% scored above the cutoff on the PHQ-8 and 16% scored in the clinically significant range for the GAD-7. An additional 30 and 21% scored in the at-risk range for depression and anxiety, respectively. Older adolescents were more likely to score within the elevated range for depression (r = 0.232, p = 0.026). Also, adolescents with severe to profound hearing loss had higher rates of depression and anxiety. Conclusions: Integration of mental health screening is needed in otology and audiology practices both to identify those who require psychological support and to provide appropriate treatment to reduce long-term impact of hearing loss on quality of life and mental health functioning in adolescents.

Objectives: Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes. Design: Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use. Results: Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence). Conclusions: The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the “whole” child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.

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