Measuring health-related quality of life in chronic otitis media in a Chinese population: cultural adaption and validation of the Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn)

Abstract

Background: The demand for assessing health-related quality of life (HRQoL) in chronic otitis media (COM) is increasing globally. The currently available Chinese-language patient-reported outcome measurement (PROM) specific for COM includes merely a limited range of related symptoms and dimensions. Hence, in this study, we aim to translate, culturally adapt, and validate the Zurich Chronic Middle Ear Inventory (ZCMEI-21) in Chinese, to enable a comprehensive evaluation of the patients' subjective health outcome in COM. Methods: We sampled and surveyed 223 COM patients at three tertiary referral centers in China, using the Chinese translation of ZCMEI-21 (ZCMEI-21-Chn) and the EQ-5D questionnaire, a generic measure of HRQoL. Confirmatory factor analysis (CFA) was performed to investigate the structural model fit to the dataset. Cronbach's α and testretest reliability coefficient were calculated to establish reliability, and correlation was tested between ZCMEI-Chn scores and EQ-5D scores for convergent validity. Results: A total of 208 adult patients with COM were included, with a mean age of 46 years (SD 14 years) and a male proportion of 41% (85/208). A modified bifactor model with ω H of 0.65 and ECV of 0.47 was found to fit the scale scores, indicating fair general factor saturation and multidimensionality of the instrument. ZCMEI-21-Chn demonstrated good reliability (Cronbach's α = 0.88, test-retest reliability = 0.88). The total scores of ZCMEI-21-Chn had a moderate correlation with a question directly addressing HRQoL (r = 0.40, p < 0.001), EQ-5D descriptive system score (r = 0.57, p < 0.001), and EQ-5D visual analogous scale (r = 0.30, p < 0.001).

Validation of a Spanish version of the health-related quality of life (HRQoL) measure for Chronic Otitis Media (COMQ-12)

“…There are some HRQoL instruments for COM such as COMOT-15 [ 13 ], CES [ 14 ], COMBI [ 15 ], ZCMEI-21 [ 16 ], and recently, the COMQ-12 questionnaire [ 1 ]. ZCMEI-21 questionnaires have been translated to different languages such as: English [ 17 ], Japanese [ 18 ], Italian [ 19 ] and Chinese [ 20 ]. Likewise, COMQ-12 questionnaire has been translated and validated to different languages including: Indian Kannada [ 12 ], Dutch [ 21 ], Serbian [ 9 ], Portuguese [ 22 ], Russian [ 23 ], Korean [ 24 ], Turkish [ 25 ], and Italian [ 26 ].…”

Middle Ear Surgeries for Chronic Otitis Media Improve Cognitive Functions and Quality of Life of Age-Related Hearing Loss Patients

“…GBI is widely used to assess the QoL of the patients after ENT surgeries with good reliability. Furthermore, GBI, Chinese version, has also been evaluated by Yang et al (2020) , with good validity and reliability. Previous studies have shown that poor social relationships are a risk factor for incident dementia in later life ( Kuiper et al, 2015 ; Livingston et al, 2017 ).…”

“…The correlation between relief of other discomforts and cognitive functions, such as otorrhea and tinnitus, was not studied. In the future studies, we will conduct COM-specific questionnaires ( Wang et al, 2003 ; Yang et al, 2020 ) on the patients and further explore the relationships between them.…”

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

“…The ZCMEI-21 was developed as a disease-specific questionnaire for assessing the HRQoL in patients with COM. The ZCMEI-21 has been translated into several languages [ 26 , 27 , 29 , 30 ] and has been successfully used in clinical studies [ 15 , 17 , 25 ]. The ZCMEI-21 consists of four subscores that cover ear-related symptoms, hearing, psychosocial effects of the disease and the use of medical resources.…”