Quality of life in postlingually deaf patients following cochlear implantation

Most cochlear implant studies are focused on improvement of speech perception associated with implantation. The goal of this study was to assess the impact of cochlear implantation on quality of life changes in Spanish users. Thirty postlingually deaf patients fitted with a cochlear implant completed the Glasgow Benefit Inventory, a questionnaire dealing with communication abilities, and an open-ended questionnaire. The Glasgow Benefit Inventory revealed a positive effect in 93% of patients. The use of a cochlear implant significantly enhanced discrimination ability, telephone use and self-confidence. A high degree of satisfaction was achieved in all situations except with background noise. Ninety-six percent of patients would recommend the operation to a friend. A dramatic improvement in quality of life following cochlear implantation is revealed by a great majority of patients. The results cannot only be explained by enhancements to auditory perception.     

Impact on quality of life after mastoid obliteration

Objectives/Hypothesis: To understand the long‐term impact on quality of life (QOL) in patients undergoing mastoid obliteration surgery for a chronically draining cavity, using the Glascow Benefit Inventory (GBI) QOL survey, and to correlate these findings to perceived changes in drainage and hearing. Study Design: Retrospective chart review. Methods: Adult patients undergoing mastoid obliteration and restoration of the middle ear space with cartilage reconstruction of the tympanic membrane, with at least 3‐year follow‐up, were contacted by phone to solicit participation. Those who agreed to participate were mailed the GBI and consent documents with a prepaid self‐addressed envelope. Results: Of 80 patients meeting the inclusion criteria, 37 were successfully contacted and agreed to participate, yielding 23 returned questionnaires. The vast majority (19 of 23; 83%) reported improved QOL after surgery, with the most positive effects seen on confidence and social situations, and patients experiencing less inconvenience, self‐consciousness, and embarrassment. Eighty‐three percent reported a perceived improvement in hearing; 74% reported an improvement in drainage. Over 90% would recommend the procedure to a family member. The average score on the GBI was 28.9, and a two‐tailed one‐sample t test showed that mastoid obliteration significantly improved QOL in our patients (t = 4.65, P < .001). There was a fairly good correlation between the perceived improvement in QOL with improvement in hearing and/or drainage. Conclusions: The GBI is a valuable tool for evaluating patient satisfaction after revision surgery for a draining cavity. This information is helpful in understanding the impact of a draining cavity on an individual's life and may be beneficial in preoperative selection and counseling.     

Health-related quality of life in children and adolescents who use cochlear implants

Objective

Examination of health-related quality of life (HRQoL) in children and adolescents who wear a cochlear implant (CI) primarily has depended on parent proxy report of the child's HRQoL rather than child self-report and generic domains rather than CI-specific issues. This study simultaneously assessed self-report ratings on a generic HRQoL instrument and a preliminary CI module in pediatric CI users. The impact of demographic factors (chronologic age, age at CI, and CI experience) on HRQoL also was explored.

Methods

This cross-sectional study included 138 children grouped by chronologic age: 4-7, 8-11 and 12-16 years. The KINDL^R questionnaire for measuring HRQoL in children and adolescents (generic) and a preliminary CI module (specific) were completed as a researcher-administered interview (4-7 years) or self-administered questionnaire (8-16 years) at CI summer camp or home. Scores were transformed to a 100-point scale with 100 representing the most positive response. The impact of chronologic age group on HRQoL ratings was evaluated using Analysis of Variance. Spearman rank-order correlations and point-biserial correlations tested associations between demographic factors and HRQoL scores. Principal factor analysis was used to discover the factor structure and internal consistency of the preliminary CI module.

Results

The youngest group (M = 82.8) rated generic HRQoL significantly more positively than older children (8-11 years: M = 75.3; 12-16 years: M = 70.4). Similar significant results emerged on the overall CI module (4-7 years: M = 79.8; 8-11 years: M = 77.8; 12-16 years: M = 71.3). The youngest group rated CI-specific items on friends and self-image more positively than older groups, but reported greater difficulties hearing teachers at school. The oldest group provided more consistent responses than younger groups on the CI module (Cronbach α = 0.72). Generic and CI module scores correlated positively (r = 0.19, p = .03) but this association reflects the strong correlation in the oldest group (r = 0.49, p = 0.0033) and camouflages non-significant results in younger groups.

Conclusion

Chronologic age impacts self-report of HRQoL for pediatric CI users such that younger children rate HRQoL more positively than older children and adolescents on a generic instrument and preliminary CI module. Older children provide more consistent responses on the CI module. Results support the need for further development of a CI-specific self-report HRQoL instrument.     

Speech perception in elderly patients following cochlear implantation

Conclusions. Elderly patients benefit from cochlear implantation in terms of speech perception and quality of life. Age alone should be no contraindication for implantation. Objective. There have been concerns whether elderly patients may perform poorly after cochlear implantation due to degenerative processes in the central and peripheral auditory systems. The purpose of this study was to analyze the benefits of cochlear implantation in elderly patients in comparison to younger recipients. Material and methods. We examined 26 postlingually deafened adults aged?>?65 years who received a cochlear implant at our center regarding preoperative findings, comorbidities, postoperative complications and quality of life. Speech perception was assessed by means of multi- and monosyllabic word recognition and compared to the results obtained by younger patients. Results. The surgical procedure was well tolerated by all patients without notable perioperative complications. In terms of speech perception, no significant differences between the elderly patients and younger recipients were noted. All patients found that cochlear implantation had a positive impact on their quality of life.     

负性生活事件对耳鸣患者生活质量的影响

目的：研究负性生活事件与耳鸣患者生活质量的关系,探讨负性生活事件在耳鸣心理咨询及康复中的作用。方法：对61例耳鸣患者和6l例正常对照者进行耳鸣残疾量表及生活事件量表问卷调查,得分进行对照及相关分析。结果：耳呜患者负性生活事件刺激量总和,与对照组比较差异有统计学意义（Z=-2．56,P〈0．05）。耳鸣患者负性生活事件发生率,与对照组比较差异无统计学意义（X2-0．05,P〉O．05）。耳鸣患者负性生活事件得分异常者发生率,与对照组比较差异有统计学意义（X2-16．68,P〈O．01）。耳鸣患者负性生活事件刺激量总和与生活质量得分有正相关性（r=0．41,P〈0,01）。结论：负性生活事件严重程度与耳鸣发病关系密切,负性生活事件可以使耳鸣患者的生活质量降低,耳鸣心理咨询及康复应重视负性生活事件。对负性生活事件的干预,能够改善耳鸣患者的生活质量,为耳鸣心理咨询及康复提供针对性的、个体化的理论依据。     

诺尔康人工耳蜗植人者的声调识别与生活质量评价

目的：评估诺尔康人工耳蜗植入者对普通话的声调识别能力和术后生活质量。方法：49例植入诺尔康人工耳蜗1年的受试者,使用课题组前期编制的声调识别测试软件,评估植入者的声调识别能力;使用Ni-jmegen人工耳蜗植入量表（NCIQ）,评估植人者术后生活质量。结果：①安静条件下声调识别率平均为67．26％,全部高于机会水平;②噪声条件下声调识别率平均为51．92％,除2例植入者的声调识别率低于机会水平外,其余均高于机会水平;③声调识别混淆矩阵结果显示,三声为较容易辨别的声调;④术后NCIQ总分及基本声音感知、高级声音感知、言语能力、自信心、活动能力和交流能力均获得改善,分别为55．4、72．4、54．0、63．4、50．7、47．3和44．7分。结论：诺尔康人工耳蜗植入者术后具有声调识别能力并可获得生活质量的改善。     

Health-related quality of life outcomes following adult cochlear implantation: A prospective cohort study

Introduction: The benefits of cochlear implantation extend beyond improved speech recognition and into overall health-related quality of life (HRQoL). Several measures of HRQoL, categorized as generic or disease specific, have been used in the cochlear implant literature. The clinical utility of generic HRQoL measures have been reported to be variable by previous investigators. The degree to which HRQoL correlates to speech perception is largely unknown.

Methods: A prospective single-subject design at a large tertiary care center. Self-reported HRQoL was measured at the preoperative and 12-month post-activation test intervals. The measures of HRQoL included a generic form, (Medical Outcome Study Short Form; SF-36), and disease specific form (Nijmegen Cochlear Implant Questionnaire; NCIQ). Speech recognition was measured at the preoperative, 6- and 12-months post-activation test intervals using the Consonant-Nucleus-Consonant (CNC) monosyllabic word test.

Results: A total of 61 patients (mean 67 years; range 30–87 years) were included in the final analysis. Average speech recognition on the CNC word test was 10% pre-operatively, and 66.7% at 12-months post-activation. The HRQoL scores improved significantly for seven of the eight subdomains of the NCIQ, and one of the nine domains of the SF-36.

Conclusion: Cochlear implantation significantly improves HRQoL, regardless of age. Disease specific measures, such as the NCIQ, are better able to demonstrate differences in HRQoL compared to general health surveys.     

Predictors of health-related quality of life in adult cochlear implant recipients in South Africa

Objective: To identify and describe predictors of health-related quality of life (HRQoL) outcomes for adult cochlear implant (CI) recipients in South Africa. Design: A retrospective study of adult CI recipients was conducted and cross-sectional HRQoL outcome data were added at the time of data collection, using the Nijmegen Cochlear Implant Questionnaire (NCIQ). Twenty-two potential predictive factors were identified from the retrospective dataset, including demographic, hearing loss, CI and risk-related factors. Multiple regression analyses were performed to identify predictor variables that influence HRQoL outcomes. Study sample: The study sample included 100 adult CI recipients from four CI programs, implanted for at least 12 months. Results: History of no tinnitus prior to CI, bilateral implantation and mainstream schooling were strongly predictive of better overall HRQoL outcomes. Factors such as age, age at implant, gender, onset of hearing loss, duration of CI use and presence of risk factors did not predict HRQoL scores. Conclusion: A range of significant prognostic indicators were identified for HRQoL outcomes in adult CI recipients. These predictors of HRQoL outcomes can guide intervention services’ informational counselling.     

Effect of comorbidity on quality of life and treatment selection in patients with squamous cell carcinoma of the head and neck

OBJECTIVES: Comorbidity is significantly associated with diminished survival and quality of life (QOL) after treatment of head and neck squamous cell carcinoma (HNSCC). We sought to determine whether comorbidity influenced pretreatment QOL scores and treatment selection in patients with HNSCC. METHODS: The medical records of all patients diagnosed with HNSCC who participated in pretreatment QOL analysis over a 15-month period were retrospectively reviewed. Patients with a history of prior treatment for head and neck cancer, unresectable, or distant metastatic disease were excluded. The University of Washington (UW) QOL questionnaire, Performance Status Scale (PSS), and Karnofsky score were used to measure pretreatment QOL. Comorbidity was graded using the Modified Medical Comorbidity Index. RESULTS: Of 75 patients who met study criteria, 33 underwent primary surgical therapy, and 42 underwent nonoperative (radiation or chemoradiation) therapy. Treatment groups did not differ with respect to patient demographics, UW QOL scores, PSS scores, Karnofsky score, or comorbidity. Treatment groups differed significantly by disease stage and primary site. Patients with advanced stage disease (III/IV) or oropharyngeal primary tumors were more likely to undergo nonoperative treatment, compared with patients with early stage disease (I/II) or oral cavity primary tumors (P < .005). No significant association was found between comorbidity and pretreatment QOL scores. CONCLUSIONS: Comorbidity was not significantly associated with treatment selection or pretreatment QOL scores in patients with HNSCC. Location of the primary tumor and disease stage were significantly associated with treatment selection. Further studies are required to determine the effect of comorbidity on patient and tumor responses to treatment.     

Children with cochlear implants: communication skills and quality of Life

Given the multidimensional scope of cochlear implants, there is a growing need to assess clinical measures related communicative abilities and more general aspects involved in the effectiveness of treatment, such as quality of life.AimTo translate and adapt an international questionnaire of quality of life to Brazilian Portuguese; to apply the questionnaire in parents of children with cochlear implant to assess quality of life of children after cochlear implantation; to analyze correlations among factors related to quality of life; to analyze correlations between quality of life and clinical measures of outcome.Methodprospective study in which parents of children with cochlear implants responded to validated instruments on quality of life and communication abilities.ResultsThe translation and adaptation of the questionnaire was satisfactorily completed. According to the data, cochlear implants had a positive effect on quality of life of the implanted children and their families. Observed correlations for the variable communication demonstrate a direct relationship between oral communication and other variables of quality of life.ConclusionsThis study makes this questionnaire available in Brazilian Portuguese. For parents of Brazilian children with cochlear implants, lexical development(acquisition and use of words) is the variable that relates most to the quality of life of their children.     

Impact of tonsillectomy on health-related quality of life and healthcare costs in children and adolescents

Background

Tonsillectomy is a common surgical intervention in children, but its efficacy is under debate. We studied whether tonsillectomy is a cost-effective intervention with a positive impact on health-related quality of life (HRQoL).

Methods

Children (aged 7–11 years) and adolescents (aged 12–15 years) undergoing tonsillectomy answered the 17D or 16D HRQoL questionnaires before tonsillectomy and at 6 and 12 months postoperatively. At the same time-points, data on the use of healthcare services and school absenteeism were collected by questionnaire.

Results

Altogether 49 children and 42 adolescents returned all HRQoL questionnaires. Tonsillectomy improved the mean total HRQoL score clinically and statistically significantly in both children (from 0.935 at baseline to 0.958 at 12 months, p = 0.002) and adolescents (from 0.930 to 0.957, p = 0.004). The mean direct self-reported healthcare service costs diminished after tonsillectomy in both groups. The mean number of days on sick leave due to oropharyngeal problems during the preceding 3 months decreased from the preoperative 4.6 days to postoperative 0.5 days (p < 0.001) in children, and from 4.9 days to 0.8 days (p < 0.001) in adolescents at 12 months.

Conclusions

Tonsillectomy improves HRQoL in both school-aged children and adolescents and reduces healthcare service needs and school absenteeism due to oropharyngeal symptoms.     

Measures of quality of life in children with cochlear implant: systematic review

The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology.ObjectiveIdentify the key aspects of quality of life assessed in children with cochlear implant.MethodThrough a systematic literature review, we considered publications from the period of 2000 to 2011.ConclusionWe concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.     

Impact of music on the quality of life of cochlear implant users: a focus group study

Objective: To study the aspects of the quality of life (QoL) on which music has an impact in adult cochlear implant (CI) users.

Methods: Thirty adult CI users aged between 18 and 81 years old with a wide range of patient characteristics and musical backgrounds participated in the study. Six focus group discussions about music in everyday life were conducted and data were analysed using template analysis based on the QoL model of the World Health Organisation Quality of Life BREF questionnaire.

Results and discussion: A theoretical framework of the impact of music on the QoL was developed. Music was reported to contribute to many aspects of physical, psychological, and social well-being in adult CI users. These positive effects of music on QoL were similar to what has been reported in the literature for normal-hearing adults. However, difficulties in music perception and enjoyment were found to have a negative impact on CI users’ QoL, especially by causing unpleasant feelings and limited participation in music-related or routine daily activities.

Conclusions: These findings suggest that an improvement in music experiences of CI users may lead to improvements in QoL and therefore support the need for music rehabilitation. However, the relative importance of music overall and of specific aspects of music for each individual should be measured for an accurate assessment of the impact of music on the QoL of CI users.     

Evaluation on health-related quality of life in deaf children with cochlear implant in China

ObjectivePrevious studies have shown that deaf children benefit considerably from cochlear implants. These improvements are found in areas such as speech perception, speech production, and audiology-verbal performance. Despite the increasing prevalence of cochlear implants in China, few studies have reported on health-related quality of life in children with cochlear implants. The main objective of this study was to explore health-related quality of life on children with cochlear implants in South-west China.Study designA retrospective observational study of 213 CI users in Southwest China between 2010 and 2013.MethodsParticipants were 213 individuals with bilateral severe-to-profound hearing loss who wore unilateral cochlear implants. The Nijmegen Cochlear Implant Questionnaire and Health Utility Index Mark III were used pre-implantation and 1 year post-implantation. Additionally, 1-year postoperative scores for Mandarin speech perception were compared with preoperative scores.ResultsHealth-related quality of life improved post-operation with scores on the Nijmegen Cochlear Implant Questionnaire improving significantly in all subdomains, and the Health Utility Index 3 showing a significant improvement in the utility score and the subdomains of ‘‘hearing,” ‘‘speech,” and “emotion”. Additionally, a significant improvement in speech recognition scores was found. No significant correlation was found between increased in quality of life and speech perception scores.ConclusionHealth-related quality of life and speech recognition in prelingual deaf children significantly improved post-operation. The lack of correlation between quality of life and speech perception suggests that when evaluating performance post-implantation in prelingual deaf children and adolescents, measures of both speech perception and quality of life should be used.