Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things?

Moberly, Aaron C.; Harris, Michael S.; Boyce, Lauren; Vasil, Kara J.; Wucinich, Taylor; Pisoni, David B.; Baxter, Jodi; Ray, Christin; Shafiro, Valeriy

doi:10.1002/lary.26791

Cited by 41 publications

(39 citation statements)

References 32 publications

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“…In addition, as difficulty with intelligibility is most pronounced in noisy surroundings, the hearing impaired may avoid these situations. This finding is in accordance with the results of a previous study ( 27 ) which also found the highest correlations between patient-reported benefit, here assessed with the Nijmegen Cochlear Implant Questionnaire, and sentence comprehension in quiet. Further, it suggests that the common clinical practice of assessing CI-aided speech comprehension in quiet is a valid approach.…”

Section: Discussionsupporting

confidence: 93%

Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

et al. 2018

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Objectives: Patient-reported outcomes gain importance for the assessment of auditory abilities in cochlear implant users and for the evaluation of auditory rehabilitation. Aims of the study were to explore the interrelation of self-reported improvements in auditory ability with improvements in speech comprehension and to identify factors other than audiological improvement that affect self-reported auditory ability.Study Design: Explorative prospective analysis using a within-subjects repeated measures design.Setting: Academic tertiary care center.Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear (bimodal hearing).Intervention: Cochlear implantation.Main Outcome Measures: Self-reported auditory ability/disability assessed by the comparative version of the Speech, Spatial and Qualities of Hearing Scale (SSQ-B), and monosyllable as well as sentence comprehension in quiet and within speech modulated noise from different directions assessed pre- as well as 3 and 6 months post-implantation.Results: Data of 17 individuals were analyzed. At the endpoint of the study, improvement of self-reported auditory ability was significant. Regarding audiometric measures, significant improvement was seen for CI-aided pure tone thresholds, for monaural CI-assisted and bimodal sentence comprehension in quiet and in speech-modulated noise that was presented from the same source or at the side of the HA-ear. Correlations between self-reported and audiometric improvements remained weak, with the exception of the improvement seen for monaural CI-aided sentence comprehension in quiet and self-perceived improvement of sound quality. Considerable correlations existed between self-reported improvements and current level of depression and anxiety, and with general self-efficaciousness. Regression analyses substantiated a positive influence of self-efficaciousness on self-reported improvement in speech comprehension and between the improvement of monaural CI-aided sentence comprehension in quiet and perceived sound quality as well as a negative influence of anxiety on self-reported improvement in spatial hearing. Self-reported improvements were significantly better in the subgroup with intensive as compared to regular rehabilitation.Conclusions: Self-reported auditory ability/disability represents an important measure for the success of bimodal CI-provision. It is influenced by personal and mental health factors that may improve CI-rehabilitation results if addressed during rehabilitation.

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Section: Discussionsupporting

confidence: 93%

Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

et al. 2018

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“…Consistent with previous studies, the total NCIQ score did not correlate with auditory measures and may not best capture CI Second, we predicted that the auditory measures used in this study would demonstrate stronger correlations with NCIQ scores than traditional clinical measures. Relations between auditory outcome measures and subdomain QOL scores were stronger than those in previous work (Olze et al, 2012 18 ; Capretta and Moberly, 2016 2 ; Moberly et al, 2018 15 ). This finding may be a result of the incorporation of speech recognition tests that could be considered more "real life" by providing greater talker variabiity and greater linguistic complexity that relate better to real-world communication environments.…”

Section: Discussioncontrasting

confidence: 62%

“…The CID W-22 word list was used in this study as previous studies have demonstrated a broad range of word recognition performance with minimal ceiling and floor effects in the adult CI population using this measure. This task was also chosen to maintain consistency in methods between the present study and our previously completed study involving many of the same participants (Moberly et al, 2018 15 ).…”

Section: Auditory and Audiovisual Measuresmentioning

confidence: 99%

“…Thirteen participants were unilateral CI users (mean age 68.1 years, SD 9.1; mean CI duration 5.4 years, SD 3.1). Twenty-five of the participants (56.8%) from this sample were also included in a previous study of QOL as it relates to auditory perception and neurocognitive outcomes in adults with CIs (Moberly et al, 2018 15 ), and minimal correlations were found between QOL and outcome measures used in that study. In the present study, we were able to expand on this knowledge with a larger sample size, additional outcome measures of increased difficulty and variability, and more specific subitem analyses.…”

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confidence: 99%

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How Does Quality of Life Relate to Auditory Abilities? A Subitem Analysis of the Nijmegen Cochlear Implant Questionnaire

et al. 2020

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Background Objective speech recognition tasks are widely used to measure performance of adult cochlear implant (CI) users; however, the relationship of these measures with patient-reported quality of life (QOL) remains unclear. A comprehensive QOL measure, the Nijmegen Cochlear Implant Questionnaire (NCIQ), has historically shown a weak association with speech recognition performance, but closer examination may indicate stronger relations between QOL and objective auditory performance, particularly when examining a broad range of auditory skills. Purpose The aim of the present study was to assess the NCIQ for relations to speech and environmental sound recognition measures. Identifying associations with certain QOL domains, subdomains, and subitems would provide evidence that speech and environmental sound recognition measures are relevant to QOL. A lack of relations among QOL and various auditory abilities would suggest potential areas of patient-reported difficulty that could be better measured or targeted. Research Design A cross-sectional study was performed in adult CI users to examine relations among subjective QOL ratings on NCIQ domains, subdomains, and subitems with auditory outcome measures. Study Sample Participants were 44 adult experienced CI users. All participants were postlingually deafened and had met candidacy requirements for traditional cochlear implantation. Data Collection and Analysis Participants completed the NCIQ as well as several speech and environmental sound recognition tasks: monosyllabic word recognition, standard and high-variability sentence recognition, audiovisual sentence recognition, and environmental sound identification. Bivariate correlation analyses were performed to investigate relations among patient-reported NCIQ scores and the functional auditory measures. Results The total NCIQ score was not strongly correlated with any objective auditory outcome measures. The physical domain and the advanced sound perception subdomain related to several measures, in particular monosyllabic word recognition and AzBio sentence recognition. Fourteen of the 60 subitems on the NCIQ were correlated with at least one auditory measure. Conclusions Several subitems demonstrated moderate-to-strong correlations with auditory measures, indicating that these auditory measures are relevant to the QOL. A lack of relations with other subitems suggests a need for the development of objective measures that will better capture patients' hearing-related obstacles. Clinicians may use information obtained through the NCIQ to better estimate real-world performance, which may support improved counseling and development of recommendations for CI patients.

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“…Humes [2003] and Humes et al [2003] showed no correlation in a similar sample as well as in a large meta-analysis. In addition, absent to low correlations between patient self-report and speech recognition have been reported in cochlear implant users [Brendel et al, 2014;McRackan et al, 2016;Ramakers et al, 2017;McRackan et al, 2018a;McRackan et al, 2018b;Moberly et al, 2018]. Together, these data support the added value of PROMs as an independent measure of patient-perceived benefit from hearing interventions.…”

Section: Discussionmentioning

confidence: 74%

Assessment of Hearing Aid Benefit Using Patient-Reported Outcomes and Audiologic Measures

et al. 2020

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Purpose: To determine the contributions to hearing aid benefit of patient-reported outcomes and audiologic measures. Methods: Independent review was conducted on audiologic and patient-reported outcomes of hearing aid benefit collected in the course of a middle ear implant FDA clinical trial. Unaided and aided data were extracted from the preoperative profiles of 95 experienced hearing aid users, and the relationships between a patient-reported outcome and audiologic measures were assessed. The following data were extracted: unaided and aided pure-tone or warble-tone thresholds (PTA), word recognition in quiet (NU-6), Speech Perception in Noise (low-/high-context SPIN), and patient-reported benefit (Abbreviated Profile of Hearing Aid Benefit, APHAB). Hearing aid benefit was defined as the difference in thresholds or scores between unaided and aided conditions, as measured in the sound field. Correlations were computed among audiologic measures and global APHAB and subscale scores of hearing aid benefit. Results: Significant improvements in all audiologic measures and APHAB scores were observed comparing unaided to aided listening (all p < 0.001). However, correlations between audiologic and patient-reported measures of aided performance or hearing aid benefit were low-to-weak or absent. No significant correlations were found between aided audiologic measures (PTA, NU-6, SPIN) and any aided APHAB scores (all p > 0.0125), and significant relationships for hearing aid benefit were absent with only few exceptions. Hearing aid benefit defined by global APHAB using NU-6 and SPIN scores showed significant but weak positive correlations (r = 0.37, p < 0.001; r = 0.28, p = 0.005, respectively) and ease of communication APHAB subscale scores (r = 0.32, p < 0.001; r = 0.33, p = 0.001, respectively). Conclusion: Hearing aid benefit assessed with audiologic measures were poor predictors of patient-reported benefit. Thus, patient-reported outcomes may provide a unique assessment of patient-perceived benefit from hearing aids, which can be used to direct hearing aid programming, training, or recommendations of alternative hearing services.

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Relating quality of life to outcomes and predictors in adult cochlear implant users: Are we measuring the right things?

Abstract: 4. Laryngoscope, 128:959-966, 2018.

Cited by 41 publications

References 32 publications

Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

Patient Benefit Following Bimodal CI-provision: Self-reported Abilities vs. Hearing Status

How Does Quality of Life Relate to Auditory Abilities? A Subitem Analysis of the Nijmegen Cochlear Implant Questionnaire

Assessment of Hearing Aid Benefit Using Patient-Reported Outcomes and Audiologic Measures

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