Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults

Abstract

Cochlear implants (CI) have increasingly been adopted in older adults with severe to profound sensorineural hearing loss as a result of the growing and aging world population. Consequently, researchers have recently shown great interest in the cost-effectiveness of cochlear implantation and its effect on quality of life (QoL) in older CI users. Therefore, a systematic review and critical evaluation of the available literature on QoL in older adult CI users was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching MEDLINE (PubMed) and the Cochrane Library and by checking the reference lists of relevant articles. Inclusion criteria were as follows: (1) the study sample were adults aged 50 years and older with postlingual onset of bilateral severe to profound hearing loss, (2) all subjects received a multi-electrode CI, and (3) QoL was assessed before and after implantation. Out of 1,093 records, 18 articles were accepted for review. Several studies demonstrated significant positive effects of cochlear implantation on QoL in older adults, but high-level evidence-based medicine is lacking. An improvement of QoL was generally reported when using disease-specific instruments, which are designed to detect treatment-specific changes, whereas the outcomes of generic QoL questionnaires, assessing general health states, were rather ambiguous. However, only generic questionnaires would be able to provide calculations of the cost-effectiveness of CI and comparisons across patient populations, diseases, or interventions. Hence, generic and disease-specific QoL instruments are complementary rather than contradictory. In general, older CI users’ QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. There is a need for a standardized, multidimensional, and comprehensive QoL study protocol including all relevant generic and disease-specific instruments to measure and compare QoL, utility, and/or daily life performance in CI users.

The Effectiveness of Unilateral Cochlear Implantation on Performance-Based and Patient-Reported Outcome Measures in Finnish Recipients

“…The patient-reported improvements show that implantation is not only effective in improving speech perception but also in alleviating activity limitations and improving QoL across a wider range of listening situations. Notably, the benefits measured with the NCIQ and SSQ in this study for a Finnish CI population are similar in magnitude to those recently reported in a systematic review by Andries et al (2021) . This similarity emerged despite possible variations across countries and languages: for example, differences in the indications for cochlear implantation between different countries and healthcare systems, or differences in perceived benefits across different languages.…”

Cognition and Cognitive Reserve in Cochlear Implant Recipients

“…This has already been observed by others. Although improvement in QoL and speech perception have been described up to and beyond 2 years, the improvement increased the most within the first 6 months of the device use ( Olze et al, 2011 ; Lenarz et al, 2012 ; Völter et al, 2018 ; Andries et al, 2021 ); only a weak association between health-related QoL and speech perception in CI users has been described in previous studies ( Moberly et al, 2017 ; Vasil et al, 2020 ). In a meta-analysis by McRackan et al (2017) covering 13 articles with 715 subjects, correlation between speech perception measures, such as word or sentence recognition in quiet and sentence recognition in noise, and QoL in total or in the different subscores was only low or even neglectable ( McRackan et al, 2017 ).…”

“…Furthermore, positive outcomes of auditory rehabilitation with regard to the quality of life (QoL), psychosocial comorbidities, and cognitive functions have been reported ( Olze et al, 2011 ; Völter et al, 2018 ; Häußler et al, 2019 ; Andries et al, 2021 ). Providing subjects with hearing loss with an adequate sensory input is supposed to help to reduce the cognitive load caused by hearing loss and to release other cognitive resources.…”

The Acoustic Change Complex in Response to Frequency Changes and Its Correlation to Cochlear Implant Speech Outcomes

“…Currently there are approximately 750,000 CIs registered worldwide. The CI has been reported to improve hearing ability and life quality in most patients, language development in children, and possibly cognitive function in old adults ( Vermeire et al, 2005 ; Claes et al, 2018 ; Andries et al, 2021 ).…”