Development of a quality of life measure for adults with bilateral cochlear implants

Abstract

Cochlear implants (CI) provide a sense of hearing to people who are severely or profoundly deaf. A single CI (unilateral) has been shown to improve quality of life (QoL) substantially and clinical practice is evolving towards two per patient (bilateral), although the incremental benefit for QoL has not yet been established definitively. There is a need for self-report measures designed specifically to quantify benefits for QoL in patients who receive a second CI, in order to evaluate the relative benefits of unilateral and bilateral implantation. The aim of the present study was to develop and validate such a measure that is suitable for adults. The sample consisted of patients from the United Kingdom National Health Service who have received two CI sequentially. The study was based on the ‘Rolls Royce’ approach.

A retrospective open-ended questionnaire and face to face interviews were carried out in the first stage. Categories from the qualitative data obtained from the responses were identified and these were the foundations on which a close-ended questionnaire was developed. In the second stage, face validity, test-retest reliability and correlations of each item were investigated and amendments were made to the questionnaire items to reflect these results. In the last stage participants were asked to fill in the amended questionnaire together with another three existing QoL questionnaires (generic and disease-specific ones). These results showed that the questionnaire under development is valid and reliable. Responses from the participants also gave an insight into the changes that they experienced as a result of receiving a second CI.

The main reports were related to experiences of increased confidence and independence levels as a result of having bilateral CI. Improvement in listening in group situations and localisation ability were also noted. Changes in participant experience were evident when they filled in the questionnaire under development and also the Speech, Spatial and Qualities of Hearing questionnaire. Better understanding of changes in QoL after receiving a second CI will help professionals to understand the benefits of bilateral implantation in adults from the users’ perspectives. This is considered to be important when deciding whether patients should be advised to opt for unilateral or bilateral CI in the future. This knowledge will also help prospective patients understand the practical benefits and limitations of one or two cochlear implants.

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