Normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global Scores for Experienced Cochlear Implant Users from a Multi-Institutional Study

Abstract

Objective: Although adult cochlear implant (CI) outcomes have primarily focused on speech recognition scores, the rigorous development of a CI-specific patient-reported outcome measure provides an opportunity for a more comprehensive and ecologically valid approach to measure the real-world functional abilities of adult CI users. Here, we report for the first time normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and global scores and variance for a large, multi-institutional sample of adult CI users. Study Design: Cross-sectional study design. Setting: CI centers in the United States. Patients: Seven hundred five adults with bilateral moderate to profound hearing loss with at least 1 year of CI use. Intervention(s): Cochlear implantation. Main Outcome Measure(s): CIQOL-35 Profile and CIQOL-10 Global scores. Results: During the development of the CIQOL instruments, 1,000 CI users from all regions of the United States were invited to participate in studies. Of these, 705 (70.5%) completed all portions of the study, and their data are reported here. Mean CIQOL domain scores were highest (indicating better function) for the emotional and social domains and lowest for listening effort. The entertainment and social domains demonstrated the widest distribution of scores and largest standard deviations, indicating greatest variability in function. Overall, there were minimal ceiling and floor effects for all domains. Conclusion: Normative scores from a large sample of experienced adult CI users are consistent with clinical observations, showing large differences in functional abilities and large variability. Normative CIQOL data for adult CI users have the potential to enhance preoperative discussions with CI candidates, improve post-CI activation monitoring, and establish standards for CI centers.

Understanding Patient Expectations Before Implantation Using the Cochlear Implant Quality of Life–Expectations Instrument

“…The mean expectation scores for each CIQOL domain and global measure for participants in the current study are displayed in Table 3. Previously published normative data for each domain of the CIQOL-35 Profile instrument for 705 adult CI users with more than 12 months of experience are also displayed in Table 3 . Comparisons suggested that potential CI users, on average, had substantially higher domain-specific outcome expectations than the functional abilities of typical CI users for all domains except emotional and social.…”

“…Thus, the results of the CIQOL-Expectations instrument can potentially serve as a guide for clinicians for preoperative counseling, especially if expectations are viewed to be unrealistic. That is, individual patient responses can be compared with published means and cumulative distributions of CIQOL-35 Profile normative data of established CI users to determine the likelihood of their outcome meeting their expectations. To our knowledge, this is the first time that such evidence will be available so that these discussions can be performed.…”

“…The pre-CI CIQOL-Expectations domain and global scores of candidate CI patients were compared with CIQOL-35 Profile domain and global score normative data . These normative data were collected in a multisite study that included 705 experienced (≥12 months) CI users.…”

“…These normative data were collected in a multisite study that included 705 experienced (≥12 months) CI users. Demographic and hearing data for the normative sample were published previously . Student t tests were used to compare mean CIQOL-Expectations domain and global scores with corresponding normative CIQOL-35 Profile domain and global scores.…”

“…The assumption of unidimensionality for each domain was analyzed with an orderedcategory CFA with diagonal weighted least squares estimation using the package lavaan in the statistical software R (R Foundation). 21 Multiple types of fit indicators were examined, including those reflective of absolute fit (standardized root mean square residual) and comparative fit indicators (comparative fit index and Tucker-Lewis index [TLI]). Next, we performed 1-parameter logistic IRT.…”