Newswise — A sizable number of the millions of Americans with untreated hearing loss suffer from sadness, depression, anxiety, social isolation, and insecurity. Additional research has found that the hearing impaired had fewer relationships, decreased social activity, and increased depression. As the population ages, more people will be afflicted with hearing loss; today, between 35 and 42 percent of those aged 65 years and older are hearing impaired.
Auditory rehabilitation can reverse the adverse affects of and dysfunction from hearing loss. Hearing aids can improve the overall quality of life (QOL) in hearing impaired adults. For patients who receive no benefit from hearing aids (HA's), cochlear implants (CI's) provide improved audiologic performance and improvements in QOL. Is one form of auditory rehabilitation preferred in terms of patient satisfaction? A new study compares the functioning, with respect to QOL, of CI patients with an average group of HA patients. By evaluating the QOL benefit from CI's with that of HA's in hearing impaired adults, the impact of auditory intervention on the functional gap between CI and HA candidates is assessed. Specifically, the degree that CI's raise deaf patients' QOL towards levels enjoyed by HA patients can be determined. Such an analysis may bring further insight about how each intervention impacts patients' lives.
The authors of "Quality of Life in Hearing Impaired Adults: The Role of Cochlear Implants and Hearing Aids" are Seth M. Cohen MD MPH, Robert F. Labadie MD PhD, Mary S. Dietrich PhD, and David S. Haynes MD, all at the Vanderbilt University Medical Center, Nashville, TN. Their findings were presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation www.entnet.org Annual Meeting and OTO EXPO, being held September 21-24, 2003, at the Orange County Convention Center, Orlando, FL. Methodology: Thirty-three cochlear implant (CI) patients who were implanted at age 50 or older and had their implant for a minimum of 12 months were identified. After exclusions, 27 patients remained in the experimental CI group. From the same audiology clinic, a random sample of 65 hearing aid (HA) patients who began using aids at age 50 or older, had bilateral hearing loss, and had used aids for at least 12 months were selected. With the same exclusions, 49 patients were in the HA control group.
Demographic, medical, and audiological data were collected from patient records. Hearing history and socioeconomic history was obtained for each study subject. For CI users, sentence recognition scores without lipreading (Central Institute for the Deaf, CID, or Hearing in Noise Test, HINT, for patients not receiving CID sentences) and length of deafness prior to implantation were obtained. For HA users, the number and type of HA's used, speech discrimination score in the better ear, and pure tone average at 500, 1000, and 2000 Hz in the better ear were also recorded.
To assess QOL, the Nijmegen Cochlear Implant Questionnaire, a health-related QOL questionnaire recently designed and validated, was used. Both CI and HA patients were separately mailed two copies of the questionnaire. The first version was for the pre-rehab state (i.e. without the CI or HA) and the second version for the post-rehab state (i.e. with the CI or HA). They were mailed at least two weeks apart and were returned anonymously. Follow-up phone calls were made to ensure receipt of the questionnaire.
Results: One hundred percent of the CI users (27/27), and 30 of the 49 HA users (61.2 percent) returned both questionnaires. Three CI and three HA users had incomplete questionnaires, leaving 24 CI and 27 HA users available for analysis. No statistically significant differences were noted in the CI users with incomplete questionnaires and CI users with complete. Key findings included:
"¢ Both HA and CI patients' received benefit from their particular auditory intervention. Among HA patients, the total post-HA QOL score (72.4 +/- 11.2) was larger than the total pre-HA QOL score (60.5 +/- 14.2). For CI patients, the total post-CI QOL score (65.6 +/- 14.0) was greater than the total pre-CI QOL score (42.0 +/- 14.9)."¢ Within the HA patients, those with lower pre-rehab speech discrimination scores had lower pre-rehab QOL scores). The median benefit scores among those with programmable aids (11.6), digital aids (9.6), and analogue aids (7.0) were not statistically significantly different (p = 0.68, Kruskal-Wallis ANOVA). Also, the number of different hearing aids tried did not correlate with the QOL benefit score among HA patients (r = -0.07, p = 0.72, Spearman correlation). "¢ Compared to the HA patients, the CI group experienced twice as much QOL benefit. This difference was statistically significant. Statistically significant inverse relationships across both groups were seen between QOL benefit score and age at intervention and current age. Results from the multiple regression analysis illustrated that after controlling for the effects of age and age at intervention, there remained a statistical toward a greater QOL benefit among the CI users than among the group of HA users (Table 3).
Conclusions: This study demonstrates that HA's and CI's can improve the overall QOL of hearing impaired adults with a trend of greater benefit among the CI patients. Furthermore, the increase in at least one sub domain (basic sound perception) was significantly larger in CI users as compared to HA patients.
This study found that despite the severity of their hearing loss, CI patients obtained at least comparable benefit as patients with milder forms of hearing loss receive from HA's. In particular, CI's narrowed the gap between elderly patients with profound hearing loss and those with less severe hearing impairment receiving HA's with respect to overall QOL and across all sub domains. Furthermore, 85.2 percent HA patients had bilateral HA's compared to only 14.3 percent of CI patients having auditory rehabilitation for both ears. Despite monoaural auditory input, CI patients still approached the QOL levels of HA patients. Perhaps, bilateral implantation would bring further improvements in QOL. This study has determined that cochlear implants has raised the physical, psychological, and social function of deaf patients closer to levels enjoyed by hearing aid patients.
RSS