Impact of depressive disorders on quality of life after middle ear surgery in patients with chronic otitis media

Abstract

Purpose The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM). Methods This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index. Results After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (β = 0.425 and β = 0.362, p < 0.001). Conclusion Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling.

Symptoms of depression, anxiety and stress in patients with chronic otitis media

“…It assesses difficulty in relaxing, nervous arousal, and being easily upset/ agitated, irritable/overactive and impatient. Recommended cut-off scores for the severity of depression are mild (between 5 and 6), moderate (7)(8)(9)(10), severe (11)(12)(13) and extremely severe (over 14). Depression scores from 0 to 4 were considered normal.…”

“…Persistent symptoms of COM cause limitations in daily routine and social interactions, markedly influencing a patient's quality of life (QOL) and mental health [5]. Recently, there has been growing interest in and recognition of the importance of psychological disorders, particularly anxiety and depression, in patients with COM [6][7][8][9]. Patients with anxiety and depressive disorders exhibit lower adherence to treatment, fewer positive health behaviors, higher risk of adverse outcomes and increased medical costs [7].…”

“…Recently, there has been growing interest in and recognition of the importance of psychological disorders, particularly anxiety and depression, in patients with COM [6][7][8][9]. Patients with anxiety and depressive disorders exhibit lower adherence to treatment, fewer positive health behaviors, higher risk of adverse outcomes and increased medical costs [7]. Anxiety and depression symptoms can have profound effects regarding the control of COM, posttreatment results, the patient's QOL and general health.…”

“…Anxiety and depression symptoms can have profound effects regarding the control of COM, posttreatment results, the patient's QOL and general health. It is surprising that only a few published studies up to date examined the actual level of anxiety or depression symptoms in COM patients and that reference to this disorders is scarce in general COM literature [7][8][9].…”

Comparison of two disease‑specific instruments assessing health-related quality of life in patients with chronic otitis media

“…It is known, that women tend to score worse in the overall assessment of QoL [34,35] and that women have higher depression rates than men [36,37]. Depressive disorders have an impact on the assessment of HRQoL independently from objective symptoms such as the hearing or the extent of the middle ear pathology [38]. Furthermore, differences in stress coping strategies exist between men and women [39].…”