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. 2019 Jul;40(6):745-753.
doi: 10.1097/MAO.0000000000002225.

General Health Quality of Life Instruments Underestimate the Impact of Bilateral Cochlear Implantation

Affiliations

General Health Quality of Life Instruments Underestimate the Impact of Bilateral Cochlear Implantation

Theodore R McRackan et al. Otol Neurotol. 2019 Jul.

Abstract

Objective: To determine the extent to which bilateral cochlear implantation increases patient-reported benefit as compared with unilateral implantation and no implantation.

Data sources: PubMed, Scopus, CINAHL, and Cochrane databases searches were performed using the keywords ("Cochlear Implant" or "Cochlear Implantation") and ("bilateral").

Study selection: Studies assessing hearing/CI-specific (CI) and general-health-related (HR) quality of life (QOL) in adult patients after bilateral cochlear implantation were included.

Data extraction: Of the 31 articles meeting criteria, usable QOL data were available for 16 articles (n = 355 bilateral CI recipients).

Data synthesis: Standardized mean difference (Δ) for each measure and weighted effects were determined. Meta-analysis was performed for all QOL measures and also independently for hearing/CI-specific QOL and HRQOL.

Conclusion: When measured using hearing/CI-specific QOL instruments, patients reported very large improvements in QOL comparing before cochlear implantation to bilateral CI (Δ=2.07 [1.76-2.38]) and medium improvements comparing unilateral CI to bilateral CI (Δ=0.51 [0.32- 0.71]). Utilization of parallel versus crossover study design did not impact QOL outcomes (χ = 0.512, p = 0.47). No detectable improvements were observed in either CI transition when using HRQOL instruments (no CI to bilateral CI: Δ=0.40 [-0.02 to 0.81]; unilateral CI to bilateral CI: Δ=0.22 [-0.02 to 0.46]).The universal nature of HRQOL instruments may render them insensitive to the medium to large QOL improvements reported by patients using hearing/CI-specific QOL instruments. Given that HRQOL instruments are used to determine the economic benefit of health interventions, these measurement differences suggest that the health economic value of bilateral cochlear implantation has been underestimated.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIG. 1.
FIG. 1.
Literature review process utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) search method.
FIG. 2.
FIG. 2.
Funnel plot of hearing and cochlear implant–specific QOL PROMs unilateral to bilateral, including subset analysis of crossover and parallel patient groups; SE = standard error; SMD = standardized mean difference.
FIG. 3.
FIG. 3.
Forest plot of hearing–specific PROMs comparing pre-implant to bilateral; CI = confidence interval; SD = standard deviation; QOL = quality of life; PROMs = patient-reported outcome measurement studies; SHQ = Spatial Hearing Questionnaire; SSQ = Speech, Spatial, and Qualities of Hearing Questionnaire; VAS = Visual Analogue Scale.
FIG. 4.
FIG. 4.
Forest plot of HRQOL PROMs comparing pre-implant to bilateral; CI = confidence interval; SD = standard deviation; QOL = quality of life; PROMs = patient-reported outcome measurement studies; EQ-5D = EuroQol 5 Dimensions; HUI-3 = Health Utilities Index 3; VAS = Visual Analogue Scale.
FIG. 5.
FIG. 5.
Forest plot of hearing and cochlear implant–specific QOL PROMs unilateral to bilateral, including subset analysis of crossover and parallel study design; CI = confidence interval; SD = standard deviation; QOL = quality of life; PROMs = patient-reported outcome measurement studies; HHIA = Hearing Handicap Inventory for Adults; NCIQ = Nijmegen Cochlear Implant Questionnaire; SSQ = Speech, Spatial, and Qualities of Hearing Questionnaire; SHQ = Spatial Hearing Questionnaire; VAS = Visual Analogue Scale.
FIG. 6.
FIG. 6.
Forest plot of HRQOL PROMs comparing unilateral to bilateral; CI = confidence interval; SD = standard deviation; QOL = quality of life; PROMs = patient-reported outcome measurement studies; GBI = Glasgow Benefit Inventory; GHSI = Global Health State Inventory; EQ-5D = EuroQol 5 Dimensions; HUI-3 = Health Utilities Index 3; VAS = Visual Analogue Scale.

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References

    1. McDermott HJ, Lech M, Kornblum MS et al. Loudness perception and frequency discrimination in subjects with steeply sloping hearing loss: possible correlates of neural plasticity. J Acoust Soc Am 1998;104:2314–25. - PubMed
    1. Peters BR, Litovsky R, Parkinson A et al. Importance of age and postimplantation experience on speech perception measures in children with sequential bilateral cochlear implants. Otol Neurotol 2007;28:649–57. - PubMed
    1. Balkany T, Hodges A, Telischi F et al. William House Cochlear Implant Study Group: position statement on bilateral cochlear implantation. Otol Neurotol 2008;29:107–8. - PMC - PubMed
    1. McRackan TR, Hand BN, Consortium CIQoL et al. Development of the Cochlear Implant-Quality of Life (CI-QOL) Item Bank. Ear and Hearing 2018. (under review). - PMC - PubMed
    1. Dorman MF, Gifford RH. Combining acoustic and electric stimulation in the service of speech recognition. International journal of audiology 2010;49:912–9. - PMC - PubMed

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