Skip to main content
SpringerLink
Log in

The impact of cochlear implantation on health-related quality of life in older adults, measured with the Health Utilities Index Mark 2 and Mark 3

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To determine the usefulness of the Health Utilities Index (HUI) in older cochlear implant (CI) recipients, the primary aims were: (1) to assess health-related quality of life (HRQoL), measured with HUI, in older CI candidates while comparing with age- and gender-matched normal-hearing controls; (2) to compare HRQoL after CI with the pre-operative situation, using HUI and the Nijmegen cochlear implant questionnaire (NCIQ). The difference between pre- and postoperative speech intelligibility in noise (SPIN) and in quiet (SPIQ) and the influence of pre-operative vestibular function on HRQoL in CI users were also studied.

Methods

Twenty CI users aged 55 years and older with bilateral severe-to-profound postlingual sensorineural hearing loss and an age- and gender-matched normal-hearing control group were included. HRQoL was assessed with HUI Mark 2 (HUI2), HUI Mark 3 (HUI3) and NCIQ. The CI recipients were evaluated pre-operatively and 12 months postoperatively.

Results

HUI3 Hearing (p = 0.02), SPIQ (p < 0.001), SPIN (p < 0.001) and NCIQ (p = 0.001) scores improved significantly comparing pre- and postoperative measurements in the CI group. No significant improvement was found comparing pre- and postoperative HUI3 Multi-Attribute scores (p = 0.07). The HUI3 Multi-Attribute score after CI remained significantly worse (p < 0.001) than those of the control group. Vestibular loss was significantly related to a decrease in HUI3 Multi-Attribute (p = 0.037) and HUI3 Emotion (p = 0.021) scores.

Conclusion

The HUI is suitable to detect differences between normal-hearing controls and CI users, but might underestimate HRQoL changes after CI in CI users over 55.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

To protect study participant privacy, data cannot be shared openly. The public availability of data was not included in the ethics approval of this study. The datamanagement part of the study protocol states that raw participant data can only be accessed by the principal investigators and cannot be shared or given to anyone outside the study team.

Code availability

Not applicable.

References

  1. WHO (2018) WHO global estimates on prevalence of hearing loss Prevention of Deafness. World Health Organisation, Geneva

    Google Scholar 

  2. D’haese PSC, De Bodt M, Van Rompaey V, Van de Heyning P (2018) Awareness of hearing loss in older adults: results of a survey conducted in 500 subjects across 5 European countries as a basis for an online awareness campaign. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55. https://doi.org/https://doi.org/10.1177/0046958018759421

  3. Buchman CA, Fucci MJ, Luxford WM (1999) Cochlear implants in the geriatric population: benefits outweigh risks. Ear Nose Throat J 78(7):489–494

    Article  CAS  Google Scholar 

  4. Agrawal Y, Pineault KG, Semenov YR (2018) Health-related quality of life and economic burden of vestibular loss in older adults. Laryngosc Invest Otolaryngol 3(1):8–15. https://doi.org/10.1002/lio2.129

    Article  Google Scholar 

  5. Claes AJ, Van de Heyning P, Gilles A, Van Rompaey V, Mertens G (2018) Cognitive performance of severely hearing-impaired older adults before and after cochlear implantation: preliminary results of a prospective, longitudinal cohort study using the RBANS-H. Otol Neurotol 39(9):e765–e773. https://doi.org/10.1097/mao.0000000000001936

    Article  PubMed  Google Scholar 

  6. Lenarz M, Sonmez H, Joseph G, Buchner A, Lenarz T (2012) Cochlear implant performance in geriatric patients. Laryngoscope 122(6):1361–1365. https://doi.org/10.1002/lary.23232

    Article  PubMed  Google Scholar 

  7. Zwolan AT, Henion AK, Segel AP, Runge AC (2014) The role of age on cochlear implant performance, use, and health utility: a multicenter clinical trial. Otol Neurotol 35(9):1560–1568. https://doi.org/10.1097/MAO.0000000000000583

    Article  PubMed  Google Scholar 

  8. Claes AJ, Van de Heyning P, Gilles A, Hofkens-Van den Brandt A, Van Rompaey V, Mertens G (2018) Impaired cognitive functioning in cochlear implant recipients over the age of 55 years: a cross-sectional study using the repeatable battery for the assessment of neuropsychological status for hearing-impaired individuals (RBANS-H). Front Neurosci 12:580. https://doi.org/10.3389/fnins.2018.00580

    Article  PubMed  PubMed Central  Google Scholar 

  9. Völter C, Götze L, Dazert S, Falkenstein M, Thomas JP (2018) Can cochlear implantation improve neurocognition in the aging population? Clin Interv Aging 13:701–712

    Article  Google Scholar 

  10. Jayakody PDM, Friedland LP, Nel NE, Martins DR, Atlas RM, Sohrabi RH (2017) Impact of cochlear implantation on cognitive functions of older adults: pilot test results. Otol Neurotol 38(8):e289–e295. https://doi.org/10.1097/MAO.0000000000001502

    Article  PubMed  Google Scholar 

  11. Mosnier I, Vanier A, Bonnard D, Lina-Granade G, Truy E, Bordure P, Godey B, Marx M, Lescanne E, Venail F, Poncet C, Sterkers O, Belmin J (2018) Long-term cognitive prognosis of profoundly deaf older adults after hearing rehabilitation using cochlear implants. J Am Geriatr Soc 66(8):1553. https://doi.org/10.1111/jgs.15445

    Article  PubMed  Google Scholar 

  12. Theofilou P (2013) Quality of life: definition and measurement. Eur J Psychol 9(1):150–162. https://doi.org/10.5964/ejop.v9i1.337

    Article  Google Scholar 

  13. Hinderink JB, Krabbe PF, Van Den Broek P (2000) Development and application of a health-related quality-of-life instrument for adults with cochlear implants: the Nijmegen cochlear implant questionnaire. Otolaryngol Head Neck Surg 123(6):756–765. https://doi.org/10.1067/mhn.2000.108203

    Article  CAS  PubMed  Google Scholar 

  14. Lin X-J, Lin IM, Fan S-Y (2012) Methodological issues in measuring health-related quality of life. Tzu Chi Med J. https://doi.org/10.1016/j.tcmj.2012.09.002

    Article  Google Scholar 

  15. Patrick DL, Deyo RA (1989) Generic and disease-specific measures in assessing health status and quality of life. Med Care 27(3 Suppl):S217-232. https://doi.org/10.1097/00005650-198903001-00018

    Article  CAS  PubMed  Google Scholar 

  16. Andries E, Gilles A, Topsakal V, Vanderveken Olivier M, Van de Heyning P, Van Rompaey V, Mertens G (2020) Systematic review of quality of life assessments after cochlear implantation in older adults. Audiol Neurotol. https://doi.org/10.1159/000508433

    Article  Google Scholar 

  17. Horsman J, Furlong W, Feeny D, Torrance G (2003) The Health Utilities Index (HUI ® ): concepts, measurement properties and applications. Health Qual Life Outcomes 1:54–54. https://doi.org/10.1186/1477-7525-1-54

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kind P (1996) The EuroQol instrument: an index of health-related quality of life. Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven, Philadelphia

    Google Scholar 

  19. Horsman JR, Furlong WJ, Feeny DH, Torrance G (2013) PRM117 - Health Utilities Index (Hui®): Population reference statistics. Value in Health 16(7):A595–A595. https://doi.org/10.1016/j.jval.2013.08.1670

    Article  Google Scholar 

  20. Boyle MH, Torrance GW, Sinclair JC, Horwood SP (1983) Economic evaluation of neonatal intensive care of very-low-birth-weight infants. N Engl J Med 308(22):1330–1337. https://doi.org/10.1056/NEJM198306023082206

    Article  CAS  PubMed  Google Scholar 

  21. Torrance GW, Boyle MH, Horwood SP (1982) Application of multi-attribute utility theory to measure social preferences for health states. Oper Res 30(6):1043–1069. https://doi.org/10.1287/opre.30.6.1043

    Article  CAS  PubMed  Google Scholar 

  22. Halpern SD, Bradley CS, Ming ME, Yang YX (2001) Reliability of the health utilities index—Mark 2 and its applicability to survivors of orthotopic liver transplantation. Liver Transpl 7(3):282–283. https://doi.org/10.1002/lt.500070320

    Article  CAS  PubMed  Google Scholar 

  23. Tonmukayakul U, Le LK, Mudiyanselage SB, Engel L, Bucholc J, Mulhern B, Carter R, Mihalopoulos C (2018) A systematic review of utility values in children with cerebral palsy. Qual Life Res 28(1):1–12. https://doi.org/10.1007/s11136-018-1955-8

    Article  PubMed  Google Scholar 

  24. Furlong WJ, Feeny DH, Torrance GW, Barr RD (2001) The Health Utilities Index (HUI®) system for assessing health-related quality of life in clinical studies. Ann Med 33(5):375–384. https://doi.org/10.3109/07853890109002092

    Article  CAS  PubMed  Google Scholar 

  25. Crowson MG, Semenov YR, Tucci DL, Niparko JK (2018) Quality of life and cost-effectiveness of cochlear implants: a narrative review. Audiol Neurotol 22(4–5):236–258. https://doi.org/10.1159/000481767

    Article  Google Scholar 

  26. Bond M, Mealing S, Anderson R, Elston J, Weiner G, Taylor RS, Hoyle M, Liu Z, Price A, Stein K (2009) The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults: a systematic review and economic model. Health Technol Assess (Winchester, England) 13(44):1–330. https://doi.org/10.3310/hta13440

    Article  Google Scholar 

  27. Francis HW, Chee N, Yeagle J, Cheng A, Niparko JK (2002) Impact of cochlear implants on the functional health status of older adults. Laryngoscope 112(8):1482–1488. https://doi.org/10.1097/00005537-200208000-00028

    Article  PubMed  Google Scholar 

  28. Lenarz T, Muller L, Czerniejewska-Wolska H, Valles Varela H, Orus Dotu C, Durko M, Huarte Irujo A, Piszczatowski B, Zadrozniak M, Irwin C, Graham PL, Wyss J (2017) Patient-related benefits for adults with cochlear implantation: a multicultural longitudinal observational study. Audiol Neurootol 22(2):61–73. https://doi.org/10.1159/000477533

    Article  PubMed  Google Scholar 

  29. Arnoldner C, Lin VY, Bresler R, Kaider A, Kuthubutheen J, Shipp D, Chen JM (2014) Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3. Laryngoscope 124(11):2586–2590. https://doi.org/10.1002/lary.24648

    Article  PubMed  Google Scholar 

  30. McRackan RT, Bauschard LM, Hatch RJ, Franko-Tobin AE, Droghini AH, Velozo RC, Nguyen RS, Dubno RJ (2018) Meta-analysis of cochlear implantation outcomes evaluated with general health-related patient-reported outcome measures. Otol Neurotol 39(1):29–36. https://doi.org/10.1097/MAO.0000000000001620

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gallacher J, Ilubaera V, Ben-Shlomo Y, Bayer A, Fish M, Babisch W, Elwood P (2012) Auditory threshold, phonologic demand, and incident dementia. Neurology 79(15):1583–1590. https://doi.org/10.1212/WNL.0b013e31826e263d

    Article  PubMed  Google Scholar 

  32. Wouters J, Bosman AJ, Damman W (1995) Realisatie van een CD voor spraakaudiometrie in Vlaanderen. Logopedie En Foniatrie: Maandblad Van De Nederlandse Vereniging Voor Logopedie En Foniatrie 67(9):218–255

    Google Scholar 

  33. van Wieringen A, Wouters J (2008) LIST and LINT: sentences and numbers for quantifying speech understanding in severely impaired listeners for Flanders and the Netherlands. Int J Audiol 47(6):348–355. https://doi.org/10.1080/14992020801895144

    Article  PubMed  Google Scholar 

  34. Stappen AVD (2000) Computerized electronystagmography: normative data revisited. Acta Otolaryngol 120(6):724–730. https://doi.org/10.1080/000164800750000243

    Article  Google Scholar 

  35. Lazard DS, Vincent C, Venail F, Van de Heyning P, Truy E, Sterkers O, Skarzynski PH, Skarzynski H, Schauwers K, O’Leary S, Mawman D, Maat B, Kleine-Punte A, Huber AM, Green K, Govaerts PJ, Fraysse B, Dowell R, Dillier N, Burke E, Beynon A, Bergeron F, Baskent D, Artieres F, Blamey PJ (2012) Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PLoS ONE 7(11):e48739. https://doi.org/10.1371/journal.pone.0048739

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Sun DQ, Ward BK, Semenov YR (2014) Bilateral vestibular deficiency: quality of life and economic implications (Report). JAMA Otolaryngol Head Neck Surg 140(6):527. https://doi.org/10.1001/jamaoto.2014.490

    Article  PubMed  PubMed Central  Google Scholar 

  37. Contrera KJ, Betz J, Deal J, Choi JS, Ayonayon HN, Harris T, Helzner E, Martin KR, Mehta K, Pratt S, Rubin SM, Satterfield S, Yaffe K, Simonsick EM, Lin FR (2016) Association of hearing impairment and anxiety in older adults. J Aging Health 29(1):172–184. https://doi.org/10.1177/0898264316634571

    Article  PubMed  PubMed Central  Google Scholar 

  38. Acar B, Yurekli MF, Babademez MA, Karabulut H, Karasen RM (2011) Effects of hearing aids on cognitive functions and depressive signs in elderly people. Arch Gerontol Geriatr 52(3):250–252. https://doi.org/10.1016/j.archger.2010.04.013

    Article  PubMed  Google Scholar 

  39. Lenarz T, Muller L, Czerniejewska-Wolska H, Vallés Varela H, Orús Dotú C, Durko M, Huarte Irujo A, Piszczatowski B, Zadrożniak M, Irwin C, Graham PL, Wyss J (2017) Patient-related benefits for adults with cochlear implantation: a multicultural longitudinal observational study. Audiol Neurootol 22(2):61–73. https://doi.org/10.1159/000477533

    Article  PubMed  Google Scholar 

  40. McRackan TR, Bauschard M, Hatch JL, Franko-Tobin E, Droghini HR, Nguyen SA, Dubno JR (2018) Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities. Laryngoscope 128(4):982–990. https://doi.org/10.1002/lary.26738

    Article  PubMed  Google Scholar 

  41. Mollenkopf H, Walker A (2007) Quality of life in old age: international and multi-disciplinary perspectives, 1st edn. Springer, Dordrecht

    Book  Google Scholar 

  42. Noble W, Jensen NS, Naylor G, Bhullar N, Akeroyd MA (2013) A short form of the speech, spatial and qualities of hearing scale suitable for clinical use: the SSQ12. Int J Audiol 52(6):409–412. https://doi.org/10.3109/14992027.2013.781278

    Article  PubMed  PubMed Central  Google Scholar 

  43. Gatehouse S, Noble W (2004) The speech, spatial and qualities of hearing scale (SSQ). Int J Audiol 43(2):85–99

    Article  Google Scholar 

  44. Cox MR, Alexander CG (1995) The abbreviated profile of hearing aid benefit. Ear Hear 16(2):176–186. https://doi.org/10.1097/00003446-199504000-00005

    Article  CAS  PubMed  Google Scholar 

  45. McRackan T, Velozo C, Holcomb M, Camposeo E, Hatch J, Meyer T, Lambert P, Melvin C, Dubno J (2017) Use of adult patient focus groups to develop the initial item bank for a cochlear implant quality-of-life instrument. JAMA Otolaryngol Head Neck Surg 143(10):975. https://doi.org/10.1001/jamaoto.2017.1182

    Article  PubMed  PubMed Central  Google Scholar 

  46. McRackan T, Hand B, Velozo C, Dubno J (2019) Cochlear implant quality of life (CIQOL): development of a profile instrument (CIQOL-35 Profile) and a global measure (CIQOL-10 Global). J Speech Lang Hear Res Online 62(9):3554–3563. https://doi.org/10.1044/2019_JSLHR-H-19-0142

    Article  Google Scholar 

  47. EUnetHTA (2015) Endpoints used for relative effectiveness assessment: health-related quality of life and utility measures. https://www.eunethta.eu/wp-content/uploads/2018/01/Endpoints-used-for-Relative-Effectiveness-Assessment-Health-related-quality-of-life-and-utility-measures_Amended-JA1-Guideline_Final-Nov-2015.pdf

Download references

Funding

The Antwerp University Hospital currently receives a research grant from the company MED-EL, Innsbruck (Austria).

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium

    Ellen Andries, Annick Gilles, Vedat Topsakal, Olivier Vanderveken, Paul Van de Heyning, Vincent Van Rompaey & Griet Mertens

  2. Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium

    Ellen Andries, Annick Gilles, Vedat Topsakal, Olivier Vanderveken, Paul Van de Heyning, Vincent Van Rompaey & Griet Mertens

  3. Department of Human and Social Welfare, University College Ghent (HoGent), Ghent, Belgium

    Annick Gilles

Authors
  1. Ellen Andries
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annick Gilles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vedat Topsakal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Vanderveken
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Van de Heyning
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vincent Van Rompaey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Griet Mertens
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

EA undertook data collection and analysis and drafted the manuscript. AG, VT, OV, PVDH, VVR and GM critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ellen Andries.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Consent to participate

All participants gave written informed consent prior to participation in accordance with the Declaration of Helsinki.

Consent for publication

Patients signed informed consent regarding using their data to write and publish this article.

Ethics approval

The study was carried out in conformity with the recommendations of the ethics committee of the University of Antwerp, Antwerp, Belgium and he University Hospital Antwerp, Antwerp, Belgium and the Declaration of Helsinki. The protocols for the control group and the CI users were approved on November 21, 2016 (protocol number: 16/43/450) and June 15, 2015 (protocol number: 15/17/181) respectively.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andries, E., Gilles, A., Topsakal, V. et al. The impact of cochlear implantation on health-related quality of life in older adults, measured with the Health Utilities Index Mark 2 and Mark 3. Eur Arch Otorhinolaryngol 279, 739–750 (2022). https://doi.org/10.1007/s00405-021-06727-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-06727-3

Keywords

Search

Navigation