Comparison of Disease-Specific, Generic, and Hearing-Specific Instruments Assessing Health-Related Quality of Life in Patients Undergoing Middle Ear Surgery for Chronic Otitis Media: A Prospective Correlational Study

Abstract

Objective: This study aimed to determine the responsiveness of three instruments (disease-specific, generic, and hearing-specific) assessing health-related quality of life (HRQoL) in adult patients undergoing surgery for chronic otitis media (COM). Study Design: Prospective correlational study. Setting: Two otology referral centers in England, United Kingdom. Patients: Consecutive adult patients undergoing middle ear surgery for COM. Main Outcome Measure(s): HRQoL assessment and audiometry were performed preoperatively and 12 months after surgery. HRQoL was assessed using disease-specific (Chronic Otitis Media Questionnaire-12 [COMQ-12]), generic (Euro-Qol-5D-5L), and hearing-specific (Hearing Handicap Inventory for Adults [HHIA]) instruments.Results: A total of 52 patients (mean [standard deviation {SD}] age, 47.3 [18.3] yr) were included, with 42 patients completing both preoperative and postoperative COMQ-12 forms. COMQ-12 and HHIA total scores significantly improved after surgery (COMQ-12: mean [SD], 28.3 [11.6] versus 14.8 [10.6]; p < 0.001; HHIA: 42.9 (28.4) versus 32.6 (27.5); p = 0.012). General HRQoL measured with the Euro-Qol-5D-5L was unaffected by surgery ( p > 0.05). The standardized response means for the COMQ-12 and HHIA total scores were 1.21 and 0.44, respectively. Postoperative air conduction thresholds were moderately correlated with the postoperative COMQ-12 (r = 0.46, p = 0.005) and HHIA (r = 0.41, p = 0.012) total scores. Conclusions: Middle ear surgery significantly improved both disease-specific and hearing-specific HRQoL, whereas general HRQoL did not change. Only the COMQ-12 is highly responsive to surgical intervention. This study supports the use of the COMQ-12 to monitor patient-reported outcomes in both research and routine clinical settings.

Health-related quality of life after otologic surgical treatment for chronic otitis media: systematic review

“…All the studies reported a statistically significant improvement in disease-specific HRQoL scores after otologic surgery among COM w/wo cholesteatoma patients. General HRQoL questionnaires did not detect an impact of surgery among COM patients w/wo cholesteatoma on the HRQoL (8,31,42,43). The significance of improvement in disease-specific HRQoL was independent of the follow-up period.…”

“…Additionally, the initial search yielded one eligible study that could not be retrieved with the updated search (43). Together, this resulted in 16 unique fulltext articles (3,8,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) for inclusion in the systematic review (Figure 1).…”

“…CES (3,(35)(36)(37)(38) and COMOT-15 (8,(31)(32)(33)(34) were used in five different studies, and the ZCMEI-21 (31, 39, 40) and COMQ-12 (42-44) in three studies. Furthermore, three general HRQoL questionnaires were used: SF-36 (8,31,43), SF-12V2 (38), and Euro-Qol-5D-5L (42). A hearing-specific QoL questionnaire (HHIA) was used once (42).…”

“…Furthermore, three general HRQoL questionnaires were used: SF-36 (8,31,43), SF-12V2 (38), and Euro-Qol-5D-5L (42). A hearing-specific QoL questionnaire (HHIA) was used once (42). Table 2 provides an overview of the content of each disease-specific HRQoL questionnaire.…”

“…The otologic surgical treatments were described as tympanoplasty (8,32,35,37,(42)(43)(44), canal wall up, and canal wall down (8,31,35,36,43). Five studies did not specify the performed otologic surgical treatment (3,34,(39)(40)(41).…”