The HEAR-QL: quality of life questionnaire for children with hearing loss

Abstract

Background: Few quality of life (QOL) assessment tools are available for children with specific chronic conditions, and none have been designed specifically for children with hearing loss (HL). A validated hearing-related QOL questionnaire could help clinicians determine whether an intervention is beneficial and whether one intervention is better than another.

Purpose: To examine QOL in children with HL and assess the validity, reliability, and factor structure of a new measure, the Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire.

Research design: A descriptive and correlational study of a convenience sample of children.

Study sample: Participants included 35 children with unilateral HL, 45 with bilateral HL, and 35 siblings with normal hearing.

Data collection and analysis: Children 7-12 yr old were recruited by mail from a tertiary-care pediatric otolaryngology practice and the local county's Special School District. With parent consent, children completed the validated Pediatric Quality of Life Inventory™ (PedsQL) 4.0 and a 35-item HEAR-QL questionnaire. The factor structure of the HEAR-QL was determined through principal components analysis (PCA), and mean scores were computed for each subscale and the total HEAR-QL. Three weeks following the return of the initial questionnaires, a second HEAR-QL questionnaire was sent to participants to assess test-retest reliability. Both PedsQL and HEAR-QL scores were compared between children with and without HL, between children with unilateral and bilateral HL, and between children who used and did not use a hearing device using analysis of variance. Sensitivity and specificity were calculated for both the HEAR-QL and the PedsQL. A multivariable, hierarchical linear regression analysis was conducted with independent variables associated with the HEAR-QL in unadjusted tests.

Results: Using exploratory PCA, the 35-item HEAR-QL was reduced to 26 items (Cronbach's α = 0.97, sensitivity of 91% and specificity of 92% at a cutoff score of 93.5) loading on three factors: difficulty hearing in certain environments/situations (Environments α = 0.97), impact of HL on social/sports activities (Activities α = 0.92), and impact of HL on child's feelings (Feelings α = 0.88). Sensitivity of 78.8% and specificity of 30.9% at a cutoff score of 69.6 on the PedsQL (at risk for impaired QOL) were lower than for the HEAR-QL. Participants with HL reported significantly lower mean total HEAR-QL scores (71 [SD 18] vs. 98 [SD 5], p < .001), but not mean total PedsQL scores (77 [SD 14] vs. 83 [SD 15], p = .47), than participants with normal hearing. Among children with bilateral HL, children who used a hearing device reported lower mean total HEAR-QL scores (p = .01), but not mean total PedsQL scores (p = .55), than children who did not use a hearing device. The intraclass correlation coefficient for test-retest reliability for the 26-item HEAR-QL total score was 0.83. Hearing status and use of a device were independently associated with the HEAR-QL, and the variables in the model accounted for 46% of the HEAR-QL total score variance.

Conclusions: The HEAR-QL appears to be a valid, reliable, and sensitive questionnaire for children with HL. The HEAR-QL was better able than the PedsQL to distinguish between children with and without HL and can help evaluate interventions for children with HL.

Figure 1

Differences in Hearing Environments and Reflection on Quality of Life (HEAR-QL) mean scores among children with unilateral HL (n = 35), bilateral HL (n = 45), and normal hearing (n = 35). Note: HL = hearing loss. * p < 0.05. ** p < 0.001.

Figure 2

Differences in Pediatric Quality of Life Inventory^™ (PedsQL^™) mean scores among children with unilateral HL (n = 35), bilateral HL (n = 45), and normal hearing (n = 35). Note: HL = hearing loss. *p < 0.05

Figure 3

Receiver operating curves for (a) the 26-item HEAR-QL questionnaire (AUC=0.959) and (b) the PedsQL questionnaire (AUC=0.625).