The music-related quality of life: Italian validation of MuRQoL into MUSQUAV questionnaire and preliminary data from a cohort of postlingually deafened cochlear implant users

Music Perception and Music-Related Quality of Life in Adult Cochlear Implant Users: Exploring the Need for Music Rehabilitation

OBJECTIVES

Cochlear implant (CI) users face difficulties in accurately perceiving basic musical elements such as pitch, melody, and timbre. Music significantly affects the quality of life (QoL) of CI users. Individually and culturally influenced music perception exceeds psychophysical measures in capturing the subjective music enjoyment of CI users. Understanding the music perception, enjoyment, and habits of CI users is crucial for approaches to improve music-related QoL (MuRQoL). Therefore, this study aims to investigate music perception skills, experiences, and participation in music activities in a large group of adult CI users, and to understand the importance of these factors and their impact on QoL of CI users.

DESIGN

This study included 214 CI recipients with diverse auditory experiences who were aged between 18 and 65 years and were unilateral, bimodal, or bilateral users for at least 1 year and 193 normal hearing (NH) controls. All participants completed the information forms and the MuRQoL questionnaire. To assess the impact of music on QoL and identify personalized rehabilitation needs, the scores for each question in both parts of the questionnaire were intersected on a matrix. Data were presented in detail for the CI group and compared between CI and NH groups.

RESULTS

A statistically significant difference was found between the matched CI and NH groups in favor of the NH group in terms of music perception and music engagement. Participants who received music education at any point in their lives had significantly higher MuRQoL questionnaire scores. There was no significant relationship found between the duration of auditory rehabilitation, pre-CI hearing aid usage, music listening modality, and MuRQoL questionnaire scores. Unilateral CI users had significantly lower scores in music perception and music engagement subsections compared with bimodal and bilateral CI users. Also, it was found that music had a strong negative impact on QoL in 67/214 of the CI users.

CONCLUSIONS

Although CI users scored significantly lower than NH individuals on the first part of the questionnaire, which asked about musical skills, enjoyment, and participation in musical activities, findings suggest that CI users value music and music enjoyment just as much. The study reveals the influence of factors such as education level, age, music education, type of hearing loss and auditory rehabilitation on music perception, music enjoyment, and participation in music activities through self-report. The results indicate that for many CI users, music has a strong negative impact on QoL, highlighting the need for personalized music interventions, the inclusion of self-report questionnaires, and music perception tests in clinical evaluations.

Spanish translation and validation of the Music-Related Quality of Life Questionnaire (MuRQoL) in postlingually deaf cochlear implant users

PURPOSE

The aim of this study was to translate and validate the "Music-Related Quality of Life Questionnaire" into Spanish (sMuRQoL) and assess its convergent validity and discriminative capacity by comparing its scores with the outcomes of the musical perception test Meludia.

METHODS

The sMuRQoL was completed by 129 patients: 55 cochlear implant (CI) users and 74 normal hearing (NH) individuals. Conducted in this study were an exploratory factor analysis, an evaluation of internal consistency, an assessment of score stability through test-retest reliability, a comparison of sMuRQoL scores between CI users and NH individuals and an examination of potential evidence of convergent validity and discriminative capacity of sMuRQoL in relation to other tools. This involved the comparison of the questionnaire scores with the Meludia outcomes.

RESULTS

The sMuRQoL demonstrated a two-dimensional structure. All the dimensions displayed high internal consistency (α = 0.879-0.945) and score stability (ICC = 0.890-0.942). There were significant differences in the Frequency test between NH and CI users (d = 1.19-1.45). There's evidence of convergent validity between the scores of the Frequency test and the results of Meludia (r = 0.242-0.645). Additionally, the Frequency test demonstrate a good discriminative capacity to identify patients with poorer musical perception.

CONCLUSIONS

The sMuRQoL is a reliable questionnaire, with adequate evidence of validity based on internal structure. This study provides an accessible, cost-effective, and quick-to-administer instrument in Spanish, optimizing available healthcare resources and bringing us closer to the patient needs.

Meludia platform as a tool to evaluate music perception in pediatric and adult cochlear implant users

PURPOSE

Music perception is one of the greatest challenges for cochlear implant (CI) users. The aims of this study were: (i) to evaluate the music perception of CI users using the online Meludia music training program as music testing platform, (ii) to compare performance among three age groups, and (iii) to compare CI users with their normal hearing (NH) peers.

METHODS

138 individuals participated, divided between children (6-10 y), adolescents (11-16 y), and adults (≥ 17 y). Five music perception tasks were evaluated: Rhythm, Spatialization, Stable/unstable, Melody, and Density. We also administered the music related quality of life (MuRQoL) questionnaire for adults, and a music questionnaire for pediatric population (6-16 y) (MuQPP).

RESULTS

A significantly higher percentage of the adolescent CI users completed the five tasks compared to the other age groups. Both pediatric and adolescent CI users had similar performance to their NH peers in most categories. On the MuRQoL, adult NH listeners reported more music exposure than CI users (3.8 ± 0.6 vs 3.0 ± 0.6, p < 0.01), but both groups reported similar levels of perceived music importance (3.4 ± 0.7 vs 3.2 ± 1.1, p = 0.340). On the MuQPP, pediatric CI users who scored highly on music perception also had higher reported questionnaire scores (54.2 ± 12.9 vs 40.9 ± 12.1, p = 0.009).

CONCLUSIONS

Meludia can be used to evaluate music perception and to use for music training in CI users of all ages. Adolescents had the highest performance in most musical tasks. Pediatric CI users were more similar to their NH peers. The importance of music in adult CI users was comparable to their NH peers.

Voice Parameters in Children With Cochlear Implants: A Systematic Review and Meta-Analysis

INTRODUCTION

An intact auditory system is essential for the development and maintenance of voice quality and speech prosody. On the contrary hearing loss affects the adjustments and appropriate use of organs involved in speech and voice production. Spectro-acoustic voice parameters have been evaluated in Cochlear Implant (CI) users, and the authors of previous systematic reviews on the topic concluded that fundamental frequency (F0) seemed preliminarily the most reliable parameter to evaluate voice alterations in adult CI users. The main aim of this systematic review and meta-analysis was to clarify the vocal parameters and prosodic alterations of speech in pediatric CI users.

MATERIALS AND METHODS

The protocol of the systematic review was registered on the PROSPERO database, International prospective register of systematic reviews. We conducted a search of the English literature published in the period between January 1, 2005 and April 1, 2022 on the Pubmed and Scopus databases. A meta-analysis was conducted to compare the values of voice acoustic parameters in CI users and non-hearing-impaired controls. The analysis was conducted using the standardized mean difference as the outcome measure. A random-effects model was fitted to the data.

RESULTS

A total of 1334 articles were initially evaluated using title and abstract screening. After applying inclusion/exclusion criteria, 20 articles were considered suitable for this review. The age of the cases ranged between 25 and 132 months at examination. The most studied parameters were F0, Jitter, Shimmer and Harmonics-to-Noise Ratio (HNR); other parameters were seldom reported. A total of 11 studies were included in the meta-analysis of F0, with the majority of estimates being positive (75%); the estimated average standardized mean difference based on the random-effects model was 0.3033 (95% CI: 0.0605 to 0.5462; P = 0.0144). For Jitter (0.2229; 95% CI: -0.1862 to 0.7986; P = 0.2229) and shimmer (0.2540; 95% CI: -0.1404 to 0.6485; P = 0.2068) there was a trend toward positive values without reaching statistical significance.

DISCUSSION AND CONCLUSIONS

This meta-analysis confirmed that higher F0 values have been observed in the pediatric population of CI users compared to age-matched normal hearing volunteers, whereas the parameters of voice noise were not significantly different between cases and controls. Prosodic aspects of language need further investigations. In longitudinal contexts, prolonged auditory experience with CI has brought voice parameters closer to the norm. Following the available evidence, we stress the utility of inclusion of vocal acoustic analysis in the clinical evaluation and follow-up of CI patients to optimize the rehabilitation process of pediatric patients with hearing loss.

Application of Patient Reported Outcome Measures in Cochlear Implant Patients: Implications for the Design of Specific Rehabilitation Programs

INTRODUCTION

Cochlear implants (CI) have been developed to enable satisfying verbal communication, while music perception has remained in the background in both the research and technological development, thus making CI users dissatisfied by the experience of listening to music. Indications for clinicians to test and train music abilities are at a preliminary stage compared to the existing and well-established hearing and speech rehabilitation programs. The main aim of the present study was to test the utility of the application of two different patient reporting outcome (PRO) measures in a group of CI users. A secondary objective was to identify items capable of driving the indication and design specific music rehabilitation programs for CI patients.

MATERIALS AND METHODS

A consecutive series of 73 CI patients referred to the Audiology Unit, University of Padova, was enrolled from November 2021 to May 2022 and evaluated with the audiological battery test and PRO measures: Musica e Qualità della Vita (MUSQUAV) and Nijmegen Cochlear Implant Questionnaire (NCIQ) Italian version.

RESULTS

The reliability analysis showed good consistency between the different PRO measures (Cronbach's alpha = 0.873). After accounting for the epidemiological and clinical variables, the PRO measures showed a correlation with audiological outcomes in only one case (rho = -0.304; adj. p = 0.039) for NCIQ-T with the CI-pure tone average. A willingness for musical rehabilitation was present in 63% of patients (Rehab Factor, mean value of 0.791 ± 0.675).

CONCLUSIONS

We support the role of the application of MUSQUAV and NCIQ to improve the clinical and audiological evaluation of CI patients. Moreover, we proposed a derivative item, called the rehab factor, which could be used in clinical practice and future studies to clarify the indication and priority of specific music rehabilitation programs.