Health-related quality of life and mental distress in patients with partial deafness: preliminary findings

Eur Arch Otorhinolaryngol (2016) 273:767–776 DOI 10.1007/s00405-015-3713-7 MISCELLANEOUS Health-related quality of life and mental distress in patients with partial deafness: preliminary findings Katarzyna Cieśla1 • Monika Lewandowska1,2 • Henryk Skar_zyński1 Received: 25 March 2015 / Accepted: 3 July 2015 / Published online: 5 August 2015 Ó The Author(s) 2015. This article is published with open access at Springerlink.com Abstract The aim of the study was to evaluate mental distress and health-related quality of life in patients with bilateral partial deafness (high-frequency sensorineural hearing loss) before cochlear implantation, with respect to their audiological performance and time of onset of the hearing impairment. Thirty-one patients and 31 normalhearing individuals were administered the Beck Depression Inventory (BDI), the State-Trait-Anxiety-Inventory (STAI) and the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Patients also completed the Nijmegen-Cochlear-Implant-Questionnaire (NCIQ), a tool for evaluation of quality of life related to hearing loss. Patients revealed increased depressive and anxiety symptoms, as well as decreased health-related quality of life (psychological health, physical health), in comparison with their healthy counterparts (t tests, p \ 0.05). Furthermore, a General Linear Model demonstrated in patients with a prelingual onset of hearing loss enhanced self-evaluated social interactions and activity (NCIQ), when their outcomes were contrasted with those obtained in individuals with postlingual partial deafness (p \ 0.05). The study failed to show any effect of collateral tinnitus. Patients not using hearing aids had better audiological performance and, therefore, better sound perception and speech production, as measured with NCIQ. There was no effect of hearing aid use with respect to mental distress. Additional statistically significant correlations seen in patients & Katarzyna Cieśla 1 Institute of Physiology and Pathology of Hearing, World Hearing Center, Mokra 17, 05-830 Warsaw/Kajetany, Poland 2 Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Torun, Torun, Poland included those between a steeper slope hearing loss configuration (averaged pure-tone thresholds at 1 and 2 kHz with subtracted threshold at 0.5 kHz) and better audiometric speech detection, between audiometric thresholds and the subjectively rated sound perception (NCIQ), as well as left-ear audiometric word recognition scores and the subjectively perceived ability to recognize advanced sounds (NCIQ). In addition, a longer duration of postlingual deafness, as well as a younger age at the onset were both related to worse speech detection thresholds. The results of the study provide evidence that successful rehabilitation in patients with partial deafness might have to go beyond the standard speech therapy. Enhancement of the regular diagnostic assessment with additional psychological tools is highly recommended. Further investigation is required as to the role of functional residual hearing, hearing aid use and tinnitus, in relation to future outcomes of cochlear implantation. Keyword Mental distress
Health-related quality of life
Partial deafness
Postlingual hearing impairment
Prelingual hearing impairment Introduction A hearing impairment is not only a disability (a communication dysfunction) but can also be perceived by an individual as a handicap with its psychosocial effects. Patients often encounter confusion, stigmatization or even mockery. The extent of the handicap, however, cannot be predicted from the audiometric profile itself. It has been argued that behavioral and affective variables have to be considered to provide successful management of the disease. Consequently, new tools are being introduced to 123 768 clinical practice measuring health-related quality of life (HRQoL) in patients, including its core element, mental health, along specific psychological tools to assess psychopathology (mental distress). Still, however, it remains extremely challenging to capture the non-tangible psychosocial aspects of hearing loss and thereby predict communication and adjustment hardships of patients, as well as their potential benefit from treatment and rehabilitation with e.g. cochlear implantation [1–5]. Whereas patients with a postlingual onset of deafness grow up with a hearing identity to suddenly or progressively be devoid of the auditory sense, those born with a hearing impairment are never exposed to a non-degraded acoustic and speech surrounding. Some authors suggest that underdeveloped communication skills at an early age can deteriorate emotional and social development (and potentially also neurological), with others arguing that an altered identity from hearing to deaf in a later-onset deafness can actually be more detrimental to mental health (see Ohre and colleagues for a review [4]). Several large- and medium-population studies have indicated increased mental distress among patients with an acquired postlingual hearing impairment (with an onset after developing language skills), as compared to the general population. Depressive/anxiety symptoms and social isolation were found most distinctive [1–8]. Findings concerning the correlation between audiological measures, such as pure-tone audiometry, and mental health have been contradictory, probably since numerous factors can contribute to the development of a mental distress and a sensory impairment can be one of those [4]. Thomas and colleagues reported a four times larger scoring above cutoff for significant anxiety/depression symptoms among patients with a hearing impairment than in the general population, with the proportion twice as large for a deficit of 70 dB and above [8]. At the same time, two example studies revealed no clear association between the objectively measured hearing-loss severity (acquired, moderate to profound) and the frequency of depressive symptoms [1, 2]. It was rather the individual attitude towards the disability, as well as their coping strategies that were indicated as major predictors of the psychological well-being [2]. In addition, these and other trials provided evidence of annoying tinnitus as a factor increasing the depressive mood in patients [1, 2, 9, 10]. Lower energy levels, greater distress and social isolation were also found in the patient population using HRQoL tools, with again none of the objective audiological measures consistently indicative of the individual quality of life [7]. Hallam and colleagues suggested that mental health in the hearing impaired was affected by the self-assessed level of communication skills, self-esteem and acceptance of the disability, as well as coexisting medical conditions [3; cf. 7]. Both trials, 123 Eur Arch Otorhinolaryngol (2016) 273:767–776 furthermore, showed lower HRQoL in women, with contradictory findings reported as to the p (...truncated)