General Health Quality of Life Instruments Underestimate the Impact of Bilateral Cochlear Implantation

McRackan, Theodore R.; Fabie, Joshua E.; Bhenswala, Prashant; Nguyen, Shaun A.; Dubno, Judy R.

doi:10.1097/mao.0000000000002225

Cited by 27 publications

(35 citation statements)

References 37 publications

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“…Second, generic PROMs are not suitable given limitations. The impact of CI on quality of life in older adults has been measured with the HUI2 and HUI3 ( Andries et al, 2021 ), however EQ-5D lacks construct validity for hearing and HUI3 exhibits ceiling effects, uses “hearing aid” in the item, and measures hearing ability through speech reception only; generic PROMs underestimate the impact of hearing intervention such as CIs ( McRackan et al, 2019a ). Therefore, it is imperative that PROMs allow for the suitable valuation of hearing intervention benefits.…”

Section: Anticipated Results and Discussionmentioning

confidence: 99%

“…Overall, this identified a clear improvement in QOL using both hearing- and CI-specific instruments and general-health QOL instruments. However, hearing- and CI-specific instruments demonstrated substantially greater improvements in QOL than general health instruments ( McRackan et al, 2018a , b , 2019a ). In addition, this analysis found negligible to low positive correlations between speech recognition scores (words in quiet, sentences in quiet, and sentences in noise) and patient self-reported functional ability ( Table 1 ).…”

Section: Introductionmentioning

confidence: 90%

“…To evaluate the impact of hearing loss on quality of life or the benefit of hearingrelated interventions on quality of life, numerous PROMs have been developed, including hearing-specific instruments, hearing-aid-specific instruments, and cochlear-implant-specific (CI) instruments (Andries et al, 2021). Health-related quality of life measures, such as the Euro-QoL (EQ-5D), the Health Utilities Index (HUI3), and the SF-36, are often used to measure health utility, but are weakly associated with hearingspecific PROMs due to the lack of items that are related to everyday functional communication and social interaction (McRackan et al, 2019a(McRackan et al, , 2021.…”

Section: Hearing Impairment and Patient-reported Outcome Measuresmentioning

confidence: 99%

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Best Practices in the Development, Translation, and Cultural Adaptation of Patient-Reported Outcome Measures for Adults With Hearing Impairment: Lessons From the Cochlear Implant Quality of Life Instruments

et al. 2021

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This manuscript summarizes available evidence-based best practices in the development, translation, and cultural adaptation of one type of outcome measure for adults with hearing impairment, patient-reported outcome measures (PROMs). It presents the development of the Cochlear Implant Quality of Life (CIQOL) instruments and the ongoing translation and cultural adaptation of the CIQOL-35 Profile from English to French as case studies and discusses useful lessons for selecting, developing, translating, culturally adapting, and using PROMs. Relevant best practice guides are introduced, described and their steps are illustrated with examples. Future trends in hearing-related PROMs, including computerized adaptive testing, patient-reported experience measures (PREMs), economic evaluation and allocation of scarce resources, and PROMs in low-resource settings, are discussed. The manuscript concludes on the lessons that can be learned from implementation science for the successful and sustainable integration of PROMs in clinical practice.

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Section: Anticipated Results and Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Section: Hearing Impairment and Patient-reported Outcome Measuresmentioning

confidence: 99%

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Best Practices in the Development, Translation, and Cultural Adaptation of Patient-Reported Outcome Measures for Adults With Hearing Impairment: Lessons From the Cochlear Implant Quality of Life Instruments

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“…Sensorineural hearing loss is often progressive; therefore, hearing aid users can expect an increase in hearing thresholds over time. 27 Therefore, even a nonsignificant improvement in speech recognition after cochlear implantation that is maintained over time would be considered a successful outcome. The primary limitation of this interpretation is cases in which speech recognition abilities with a cochlear implant are relatively poor and the cochlear implant provides little functional benefit.…”

Section: Limitationsmentioning

confidence: 99%

Individual Differences in Speech Recognition Changes After Cochlear Implantation

Dornhoffer

Reddy

Meyer

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition.OBJECTIVE To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6-or 12-month postoperative measures using 1 or more speech recognition tests were studied. EXPOSURES Cochlear implantation.MAIN OUTCOMES AND MEASURES Postoperative word recognition (consonant-nucleusconsonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error.RESULTS Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were -0.12 (95% CI, -0.23 to -0.01) for word recognition, -0.22 (95% CI, -0.34 to -0.10) for sentence recognition, and -0.10 (95% CI, -0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition out...

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“…Hearing aids and cochlear implants should be regarded as symptomatic treatments that are able to restore functionality (i.e., communication) and quality of life to a certain level. Bilateral cochlear implantation has been reported to restore binaural hearing to a certain level and improve speech comprehension, while reducing tinnitus burden and psychological comorbidities (8)(9)(10). However, in most health services, adult cochlear implantation is only reimbursed in a single ear because of its significant cost (10,11).…”

Section: Rehabilitation Of Hearing Lossmentioning

confidence: 99%

Making the Case for Research on Disease-Modifying Treatments to Tackle Post-lingual Progressive Sensorineural Hearing Loss

Rompaey

2020

Front. Neurol.

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Hearing loss not only has a significant impact on the quality of life of patients and society, but its correlation with cognitive decline in an aging population will also increase the risk of incident dementia. While current management of hearing loss is focused on hearing rehabilitation (and essentially symptomatic), patients are suffering from the burden of progressive hearing loss before hearing aids or cochlear implants are fitted. Although these devices have a significant effect on speech understanding, they do not always lead to normal speech understanding, especially in noisy environments. A significant number of patients suffer from autosomal dominantly inherited disorders that can produce progressive sensorineural hearing loss. This includes DFNA9, a disorder caused by pathologic variants in the COCH gene that leads to post-lingual profound sensorineural hearing loss and bilateral vestibulopathy. Carriers of a pathogenic variant leading to DFNA9 can be diagnosed at the pre-symptomatic or early symptomatic stage which creates a window of opportunity for treatment. Preventing hearing loss from occurring or stabilizing progression would provide the opportunity to avoid hearing aids or cochlear implants and would be able to reduce the increased incidence of dementia. While innovative therapies for restoration of hearing have been studied for restoration of hearing in case of severe-to-profound sensorineural hearing loss and congenital hearing loss, further research is needed to study how we can modify disease progression in late-onset autosomal dominant hereditary sensorineural hearing loss. Recently, gene editing strategies have been explored in autosomal dominant disorders to disrupt dominant mutations selectively without affecting wild-type alleles.

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General Health Quality of Life Instruments Underestimate the Impact of Bilateral Cochlear Implantation

Cited by 27 publications

References 37 publications

Best Practices in the Development, Translation, and Cultural Adaptation of Patient-Reported Outcome Measures for Adults With Hearing Impairment: Lessons From the Cochlear Implant Quality of Life Instruments

Best Practices in the Development, Translation, and Cultural Adaptation of Patient-Reported Outcome Measures for Adults With Hearing Impairment: Lessons From the Cochlear Implant Quality of Life Instruments

Individual Differences in Speech Recognition Changes After Cochlear Implantation

Making the Case for Research on Disease-Modifying Treatments to Tackle Post-lingual Progressive Sensorineural Hearing Loss

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