The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study

THIEME 338 Original Research The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study Pia Bergman1,2,3 Björn Lyxell4,5 Henrik Harder3 1 Department of Otorhinolaryngology, Jönköping County hospital, Jönköping, Sweden 2 Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden 3 Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden 4 Department of Special Needs Education, Oslo University, Oslo, Norway 5 Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden 6 Faculty of Medicine and Health, Örebro University, Örebro, Sweden Elina Mäki-Torkko2,3,5,6 Address for correspondence Pia Bergman, MD, Department of Otorhinolaryngology, Linköping University Hospital, Länssjukhuset Ryhov, Jönköping, 55185, Sweden (e-mail: ). Int Arch Otorhinolaryngol 2020;24(3):338–346. Abstract Keywords ► health-related quality of life ► cognition ► cochlear implantation ► anxiety ► depression received March 27, 2019 accepted September 24, 2019 published online December 13, 2019 Introduction Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment. Objective To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome. Methods A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years. Results Speech recognition and the overall health-related quality of life improved one year post-CI (p ¼ 0.000), without correlation (ρ¼ 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI (p ¼ 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI (p ¼ 0.036), and deteriorated three years post-CI (p ¼ 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men (p ¼ 0.009). Conclusion The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute. DOI https://doi.org/ 10.1055/s-0039-3399540. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil The Outcome of Unilateral Cochlear Implantation in Adults Introduction Hearing impairment (HI) is the 4th most common chronic disease worldwide;1 it affects 1.2 billion people, and this rate is steadily increasing. The prevalence of severe to profound HI (pure tone average [PTA] at 0.5–4 kHz 70 dB in the best ear or a speech recognition [SR] score 30%) is of 0.2% in the Swedish adult population, which is of  22,000 individuals.2 One of the main impacts of HI is the decreased ability to communicate. Hearing impairment has a negative influence on health-related quality of life (HRQoL),3,4 and the severity of the hearing loss correlates with the reduction in HRQoL.3 It has become more and more common to measure the impact of health interventions in terms of HRQoL, including an evaluation of the outcome of the cochlear implantation (CI), and there are several definitions of HRQoL, as well as several different methods to measure it. Hearing impairment is significantly associated with depression, especially among women.5 In a recent study,6 anxiety and depression were found to be more common and more severe in individuals with severe to profound HI (PTA > 70 dB in the better ear at 0.5 kHz, 1 kHz, 2 kHz and 4 kHz) than in the general population.6 Hearing-impaired older adults have a higher incidence of hospitalization than those with normal hearing,7 and HI has also been shown to be a risk factor for mortality.7,8 Cochlear implantation is a safe and effective intervention for severe to profound HI in adults.9 The general indication for CI is an inability to communicate using spoken language despite having optimally-programmed hearing aids (HAs). There are no definitive criteria for CI, but the current benchmark is PTA (0.5 kHz, 1 kHz, 2 kHz, 4 kHz) 70 dB HL and SR 50% correct repeated words in the better ear with HAs; the criteria can be more lenient in case of rapid progression.10 Several studies show a significant improvement in SR after CI,11–13 as well as a significant improvement in HRQoL, measured in different ways: SF-36 (The Short Form 36 questions),11–13 NCIQ (Nijmegen Cochlear Implant Questionnaire),11,14,15 GBI (Glasgow Benefit Inventory)15,16 and Health Utilities Index 2 and 3 HUI2-3 (Health Utilities Index 2-3)12,13. Based on the register data, one study6 found a lower risk of negative impact on HRQoL among CI users compared with individuals with severe to profound HI without CI. Hirschfelder et al17 have shown a correlation between SR and HRQoL (using the NCIQ and SF-36) in adults with severe HI who were submitted to CI, but other studies have failed to replicate this result (using the NCIQ and SSQ [Speech, Spatial and Qualities]12 and the NCIQ, GBI and HUI3 questionnaires15). A meta-analysis18 of 14 articles, involving a total of 679 CI patients, resulted in a low correlation between patientreported outcome measures, including HRQoL and SR, which, according to the authors, supports the need for a more regular use of HRQoL instruments to assess CI outcomes.18 There are several publications reporting the long-term outcome of SR and HRQoL among adult CI users. No significant growth or decline in speech perception is observed after 6–24 months post-CI.19,20 When investigating the elderly Bergman et al. group of CI users (70 years), the same stable results regarding SR and HRQoL are shown.21,22 Previous results suggest different predictive factors for post-CI performance, such as age,23,24 gender,25 duration of deafness,26 residual hearing,27 cognitive parameters,23 etiology24 and psychosocial factors.28 Objective The first aim of the present study was to examine (...truncated)