Late Bilateral Sequential Cochlear Implant and Quality of Life

Mendes, Larissa Claret De Lima; Borges, Alda; Caldas, Fernanda; Barbosa, Juliano Passos; Bahmad Jr, Fayez

doi:10.1055/s-0043-1776721

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Original Research • Int Arch Otorhinolaryngol 28 (2) • 2024 • https://doi.org/10.1055/s-0043-1776721 copy

Late Bilateral Sequential Cochlear Implant and Quality of Life

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Hearing impairment is one of the main disorders that can interfere with the development of speech and language. In an individual, it can cause significant communication difficulties, social isolation, negative feelings, and depressive disorders. The hearing aids (HAs) and cochlear implant (CI) are options for profound and severe hearing loss, and the CI can be indicated for individuals who do not obtain benefits from HAs.

Objective

To evaluate the quality of life of individuals who underwent sequential bilateral CIs with a long surgical interval between procedures.

Methods

Fifteen patients, aged 8 to 70 years old, who underwent sequential bilateral CI, with an interval ≥ 4 years between surgeries, were evaluated. Quality of life was evaluated using three questionnaires: WHOQOL-BREF, SSQ-12 and HHIA in Portuguese.

Results

The WHOQOL-BREF questionnaire showed that the study participants had a good quality of life in all domains assessed. According to the SSQ-12, few reported inability to listen in communication situations. Most individuals were classified as having medium disability by the HHIA, but the social and emotional effects did not significantly affect the quality of life.

Conclusion

The use of questionnaires to assess the quality of life of patients with hearing impairment is a valuable tool to measure adaptation to CI. Patients undergoing bilateral sequential CI, even with a long interval between procedures, presented high indices of quality of life.

Keywords
quality of life; cochlear implant; hearing loss; questionnaire

Instructions:
This questionnaire asks how you feel about your quality of life, health, and other areas of your life. Please answer all the questions. If you are unsure about which response to give to a question, please choose the one that appears most appropriate. This can be your first response.
Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about your life in the last two weeks.
For example, thinking about the last two weeks, a question might be:
How much do you worry about your health?
Not at all	A little	A moderate amount	Very much	An extreme amount
1	2	3	4	5
You should circle the number that best fits how much you have worried about your health over the last two weeks. So you would circle the number 4 if you worried about your health "very much."
How much do you worry about your health?
Not at all	A little	A moderate amount	Very much	An extreme amount
1	2	3	4	5
If you have worried "Not at all" about your health, you would circle number 1. Please read each of the following questions, assess your feelings, and circle the number on the scale for each question that fits best for you.

Please read the question, assess your feelings OVER THE LAST TWO WEEKS and circle the number on the scale for each question that gives the best answer for you.
		Very poor	Poor	Neither poor nor good	Good	Very good
1	How would you rate your quality of life?	1	2	3	4	5
		Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
2	How satisfied are you with your health?	1	2	3	4	5
The following questions ask about how much you have experienced certain things in the last two weeks.
		Not at all	A little	A moderate amount	Very much	An extreme amount
3	To what extent do you feel that physical pain prevents you from doing what you need to do?	1	2	3	4	5
4	How much do you need any medical treatment to function in your daily life?	1	2	3	4	5
5	How much do you enjoy life?	1	2	3	4	5
6	To what extent do you feel your life to be meaningful?	1	2	3	4	5
7	How well are you able to concentrate?	1	2	3	4	5
8	How safe do you feel in your daily life?	1	2	3	4	5
9	How healthy is your physical environment?	1	2	3	4	5
The following questions ask about how completely you have experienced or were able to do certain things in the last two weeks. Circle your best answer number.
		Not at all	A little	A moderate amount	Very much	Extremely
10	Do you have enough energy for everyday life?	1	2	3	4	5
		Not at all	A little	A moderate amount	Very much	Extremely
11	Are you able to accept your body appearance?	1	2	3	4	5
12	Have you enough money to meet your needs?	1	2	3	4	5
13	How available to you is the information you need in your day-to-day life?	1	2	3	4	5
14	To what extent do you have the opportunity for leisure activities?	1	2	3	4	5
15	How well are you able to get around physically?	1	2	3	4	5
The following questions ask about how good or satisfied you have felt about aspects of your life over the last two weeks.
		Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
16	How satisfied are you with your sleep?	1	2	3	4	5
17	How satisfied are you with your ability to perform your daily living activities?	1	2	3	4	5
18	How satisfied are you with your capacity for work	1	2	3	4	5
19	How satisfied are you with yourself?	1	2	3	4	5
20	How satisfied are you with your personal relationships?	1	2	3	4	5
21	How satisfied are you with your sex life?	1	2	3	4	5
22	How satisfied are you with the support you get from your friends?	1	2	3	4	5
23	How satisfied are you with the conditions of your living place?	1	2	3	4	5
24	How satisfied are you with your access to health services?	1	2	3	4	5
25	How satisfied are you with your transport?	1	2	3	4	5
The following question refers to how often you have felt or experienced certain things in the last two weeks.
		Never	Seldom	Quite often	Very often	Always
26	How often do you have negative feelings such as blue mood, despair, anxiety, or depression?	1	2	3	4	5

Domains	QOL Features
Domain: Physical	Pain and discomfort
	Energy and fatigue
	Sleep and rest Activities of Daily Living
	Dependence on medicinal substances and medical aids
	Work Capacity
Domain: Psychological	Positive feelings
	Negative feelings
	Thinking, learning, memory, and concentration
	Self-esteem
	Bodily image and appearance
	Spirituality/Religion/Personal beliefs
Domain: Social relationships	Personal relationships
	Social support
	Sexual activity
Domain: Environment	Financial resources
	Freedom, physical safety, and security
	Health and social care: accessibility and quality
	Home environment
	Opportunities for acquiring new information and skills
	Participation in and opportunities for recreation/leisure activities
	Physical environment (pollution/noise/traffic/climate)
	Transport
Domain: General (Quality Self-Assessment)	Quality of life and health perceptions

Domain	Questions
Self-assessment of quality of life	1 and 2
Physical	3, 4, 10, 15, 16, 17, and 18
Psychological	5, 6, 7, 11, 19, and 26
Social relationships	20, 21 e 22
Environment	8, 9, 12, 13, 14, 23, 24, and 25

SSQ49index	SSQ12index	Item	Pragmatic subscale
1.1	1	You are talking with one other person and there is a TV on the same room. Without turning the TV down, can you follow what the person you are talking to says?	Speech in noise
1.10	2	You are listening to someone talking to you, while at the same time trying to follow the news on TV. Can you follow what both people are saying?	Multiple speech streams
1.11	3	You are in conversation with one person in a room where there are many other people talking. Can you follow what the person you are talking to is saying?	Speech in speech
1.4	4	You are in a group of about five people in a busy restaurant. You can see everyone else in the group. Can you follow the conversation?	Speech in noise
1.12	5	You are with a group, and the conversation switches from one person to another. Can you easily follow the conversation without missing the start of what each new speaker is saying?	Multiple speech streams
2.6	6	You are outside. A dog barks loudly. Can you tell immediately where it is, without having to look?	Localization
2.9	7	Can you tell how far away a bus or a truck is, from the sound?	Distance and movement
2.13	8	Can you tell from the sound whether a bus or truck is coming toward you or going away?	Distance and movement
3.2	9	When you hear more than one sound at a time, do you have the impression that it appears to be a single jumbled sound?	Segregation
3.7	10	When you listen to music, can you make out which instruments are playing?	Identification of sound
3.9	11	Do everyday sounds that you can hear easily seem clear to you (not blurred)?	Quality & Naturalness
3.14	12	Do you have to concentrate very much when listening to someone or something?	Listening effort

	HEARING HANDICAP INVENTORY FOR ADULTS (HHIA) NAME: DATE:
		YES (4)	SOME- TIMES (2)	NO (0)
S-1.	Does a hearing problem cause you to use the phone less often than you would like?
E-2.	Does a hearing problem cause you to feel embarrassed when meeting new people?
S-3.	Does a hearing problem cause you to avoid groups of people?
E-4.	Does a hearing problem make you irritable?
E-5.	Does a hearing problem cause you to feel frustrated when talking to members of your family?
S-6.	Does a hearing problem cause you difficulty when attending a party?
S-7.	Does a hearing problem cause you difficulty hearing/understanding coworkers, clients, or customers?
E-8.	Do you feel handicapped by a hearing problem?
S-9.	Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors?
E-10.	Does a hearing problem cause you to feel frustrated when talking to coworkers, clients, or customers?
S-11.	Does a hearing problem cause you difficulty in the movies or theater?
E-12.	Does a hearing problem cause you to be nervous?
S-13.	Does a hearing problem cause you to visit friends, relatives, or neighbors less often than you would like?
E-14.	Does a hearing problem cause you to have arguments with family members?
S-15.	Does a hearing problem cause you difficulty when listening to TV or radio?
S-16.	Does a hearing problem cause you to go shopping less often than you would like?
E-17.	Does any problem or difficulty with your hearing upset you at all?
E-18.	Does a hearing problem cause you to want to be by yourself?
		YES (4)	SOME- TIMES (2)	NO (0)
S-19.	Does a hearing problem cause you to talk to family members less often than you would like?
E-20.	Do you feel that any difficulty with your hearing limits or hampers your personal or social life?
S-21.	Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?
E-22.	Does a hearing problem cause you to feel depressed?
S-23.	Does a hearing problem cause you to listen to TV or the radio less often than you would like?
E-24.	Does a hearing problem cause you to feel uncomfortable when talking to friends?
E-25.	Does a hearing problem cause you to feel left out when you are with a group of people?

	Statistics	Age (years old)	Interval Between Implants (years)	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12
n = 15
	Mean	30.4	9.3	7.0	5.0	6.1	6.0	5.3	6.8	7.1	7.0	5.3	6.5	7.8	6.1
	SD	16.9	4.3	2.6	2.7	2.5	2.1	2.2	2.6	1.9	3.3	2.6	2.7	2.8	2.6
	Minimum	8.0	4.0	2.0	0.0	2.0	3.0	2.0	0.0	4.0	0.0	0.0	2.0	2.0	2.0
	Maximum	70.0	19.0	10.0	10.0	10.0	10.0	10.0	10.0	10.0	10.0	10.0	10.0	10.0	10.0
	CV	55.5%	46.5%	36.6%	53.5%	42.0%	34.5%	41.5%	38.2%	26.9%	47.4%	49.4%	41.7%	35.8%	42.2%

Age (Years old)	Age at 1st CI (Years old)	Time interval between implants (Years)	Age at 2nd CI (Years old)	Time of hearing aid use before CI (Years)	HHIA - S (Mean)	HHIA – E (Mean)	HHIA TOTAL (Mean)	SSQ12 (Mean)
8	3 (RE)	4	7 (RE)	2 (LE) 6 (RE)	20	0	20	5,08
13	1 (LE)	10	11 (LE)	0 (RE)11 (LE)	14	16	30	6,58
16	3 (RE)	10	13 (LE)	1 (RE) 11(LE)	30	38	68	6,83
17	5 (RE)	11	16 (LE)	1 (RE) 12 (LE)	18	32	50	4.08
19	1 (RE)	15	16 (LE)	1 (RE) 15 (LE)	8	14	22	7
26	2 (RE)	19	21 (LE)	19 (LE) 0 (RE)	2	0	2	9,41
26	4 (RE)	11	15 (LE)	3 (RE) 14 (LE)	26	32	58	7,56
26	16 (LE)	4	20 (RE)	14 (LE) 18 (RE)	10	12	22	5,58
30	17 (RE)	9	26 (LE)	13 (RE) 22 (LE)	42	34	76	3,33
32	23 (RE)	5	28 (LE)	16 (RE) 21 (LE)	14	24	38	7,66
34	15 (LE)	16	31 (RE)	9 (LE) 25 (RE)	28	30	58	8
37	30 (LE)	4	34 (RE)	22 (LE) 26 (RE)	44	50	94	4,16
43	22 (LE)	10	32 (RE)	16 (LE) 26 (RE)	16	22	38	6,91
59	41 (LE)	10	51 (RE)	10 (LE) 20 (RE)	6	10	16	7,25
70	62 (LE)	4	66 (RE)	32 (LE) 36 (RE)	20	4	24	6,58

	Statistics	HHIA - Emotional	HHIA - Social	HHIA - Total
n = 15
	Mean	20.8	19.6	40.4
	SD	15.2	11.8	25.7
	Minimum	0.0	2.0	2.0
	Maximum	50.0	44.0	94.0
	CV	73.2%	60.3%	63.5%

	HHIA - Social	HHIA - Total
HHIA - Emotional	r = 0.80	r = 0.96
	p < 0.001	p < 0.001
HHIA - Social		r = 0.93
		p < 0.001

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[1] Address for correspondence Fayez Bahmad Jr, Health Science School, University of Brasilia, SMHN QD 02 BLOCO C ED DR CRISPIM SALA 515 ASA NORTE, Brasilia, Federal District 70710149, Brazil (e-mail: fayezbjr@gmail.com).