The HEAR-QL: quality of life questionnaire for children with hearing loss

Quality of life in children with unilateral hearing loss undergoing cochlear implantation: A systematic review and meta-analysis

OBJECTIVES

Children with Single-Sided Deafness (SSD) may experience a range of developmental challenges. While cochlear implantation has demonstrated significant improvements in hearing, its impact on Quality of Life (QoL) remains underreported. This review evaluates how cochlear implantation for SSD influences the quality of life in children.

METHODS

A systematic review was conducted following the PRISMA guidelines across nine different databases, without language restrictions, including articles indexed up to December 15, 2023. Eligible studies included patients up to 18-years-old; severe to profound unilateral hearing loss, and normal contralateral hearing; cochlear implantation with more than 3 months of follow-up; QoL assessed by structured questionnaires. Meta-analysis compared QoL scores obtained between pre- and post-operative periods for time of onset or hearing loss (congenital vs. post-lingual), evaluated by parents and children, and the effective cochlear implant usage time.

RESULTS

A total of 296 articles were identified, with 6 eligible for qualitative analysis and 3 for meta-analysis, involving 187 patients. The mean age at implantation was 5.8 years, with an average auditory deprivation time of 3.8 years. Both the congenital and post-lingual groups demonstrated improvement in QoL, with a mean increase of 1.51 points in children's evaluations (p-value < 0.001) and 2.70 points in parental perspectives (p-value < 0.001), assessed on a 10-point scale. The estimated effective device use time was 8.8 h per day, with 8.55 h per day for the congenital group and 10.37 h per day for the post-lingual group. There was no statistically significant difference in usage time between the two groups (p-value = 0.140).

CONCLUSION

The results indicated a significant improvement in QoL, as reported by both parents and through self-assessment. The treatment also demonstrated high levels of adherence. Both congenital and post-lingual groups yielded similar outcomes in terms of QoL and device usage time.

Validation of the Vanderbilt Classroom Listening Assessment Short Survey for Children With Unilateral Hearing Loss

OBJECTIVES

Children with unilateral hearing loss experience difficulties in classroom listening situations. There are a limited number of validated questionnaires available for monitoring listening development and quantifying the challenges school-aged children with unilateral hearing loss experience. The purpose of this study was to evaluate a survey that describes the classroom listening challenges reported by children with unilateral hearing loss with and without the use of personal hearing devices (air conduction hearing aid, bone conduction hearing aid, cochlear implant, contralateral routing of signals system).

DESIGN

Children aged 9 to 17 years with self-reported unilateral hearing loss completed an online survey about classroom listening difficulties when not using a personal hearing device (n = 1148) or with the use of a personal hearing device (n = 897). The survey includes 15 questions examining different situations common in modern classrooms. Each question includes a picture depicting the described listening situation. Exploratory factor analysis was used to develop subscales and the internal reliability of the subscales was evaluated. To validate the survey, the relationships between survey scores and self-reported hearing difficulties (without a personal hearing device) or type of device (with a personal hearing device) were evaluated using regression analyses.

RESULTS

Factor analysis revealed survey scores for individual items statistically loaded onto three factors. On the basis of these factors, subscales were created, which are related to: (1) listening situations where the talker is faraway from the child, (2) listening situations where the talker is close to the child and they are inside a building, and (3) listening situations where the talker is close to the child and they are outside a building. Regression analyses revealed children reported the greatest difficulty in school settings when the sound of interest was faraway from them. Although scores were generally higher, indicating listening was easier, when children were wearing their personal hearing devices (i.e., air conduction hearing aid, bone conduction hearing aid, contralateral routing of signals system, cochlear implant), situations with faraway signals were still reported as more challenging than were situations where signals were close.

CONCLUSIONS

This set of findings highlights the need to incorporate distance effects into laboratory evaluations that include children with unilateral hearing loss. In addition, the findings support clinical interventions that address talker-to-listener distances, such as preferential seating and remote microphone systems. Last, the results of this study validate the Vanderbilt Classroom Listening Assessment Short Survey for use with children aged 9 to 17 years of age with unilateral self-reported hearing difficulty. The subscales are empirically driven, internally reliable, and focus on three types of listening situations encountered in classrooms. It is important to note that the survey results demonstrate the expected pattern of results, with participants who have greater self-reported hearing difficulty rating classroom listening situations as more difficult than participants with less self-reported hearing difficulty.

Factors Associated With Hearing-Related Quality of Life in Children With Hearing Loss

OBJECTIVE

Our objective was to determine how hearing-related quality of life (HEAR-QL) varies with time and explore its association with hearing loss (HL) characteristics in children aged 7-18 years old.

STUDY DESIGN

Retrospective chart review.

METHODS

Medical records of 7-18 year-olds with HL who completed ≥ 1 HEAR-QL questionnaire were reviewed. Longitudinal HEAR-QL changes were explored using mixed linear models.

RESULTS

Data from 109 children with HL were analyzed. Most recent total HEAR-QL score was not associated with HL severity. Median score differences were estimated at 7.6 (slight/mild-moderate/moderately severe; 95% CI -2.3 to 15.7), 2.16 (slight/mild-severe/profound; 95% CI -9.0 to 11.2), and -3.9 (moderate/moderately severe-severe/profound; 95% CI -11.6 to 2.7). In children without changes in device use, there were no changes over time in HEAR-QL Environments/Situations, Activities/Social, or School scores. Feelings score increased by 2.9 points (95% CI 1.5-4.3) with each additional year of age. In six children who initiated device use between surveys, total HEAR-QL scores increased by a median of 15.2 points (95% CI 3.0-41.7) after device initiation.

CONCLUSIONS

In children with HL, overall HEAR-QL scores remained similar over time and between HL severity categories. Feelings scores appeared to increase with age as children adjusted to their diagnosis. In a subset of children, HEAR-QL scores increased after device initiation. Clinicians may consider recommending hearing devices for children whose QOL is significantly impacted by HL, regardless of severity. Additional investigation is necessary to further characterize how QOL changes after device initiation.

LEVEL OF EVIDENCE: 4

Unheard Struggles: Exploring Health-Related Quality of Life Determinants and Coping Mechanisms Among Children with Hearing Loss from Parents and Caregivers Perspective

Purpose

Childhood hearing loss is an emerging public health concern. This study aimed to compare the quality of life (QOL) and coping strategies between children with and without hearing loss. It also explored the impact of coping strategies on the QOL of children with hearing loss.

Methods

The study included 95 children with hearing loss and 107 healthy controls aged 6-18 years, recruited from special education schools. QOL was evaluated using the SF-12 health survey, and coping strategies were assessed with the Brief COPE inventory. Data analysis was conducted using descriptive and inferential statistics.

Results

Children with hearing loss reported lower QOL scores in areas such as role functioning, emotional well-being, mental health, and physical health. They were more likely to use maladaptive coping strategies like denial, behavioral disengagement, and self-blame, whereas healthy children favored adaptive strategies like self-distraction, emotional support, and positive reframing. Problem-focused coping showed a positive association with role functioning (r = 0.46, p < 0.01), emotional roles (r = 0.18, p < 0.05), and mental health (r = 0.19, p < 0.05). Sociodemographic factors, including grade level and rural residence, significantly influenced QOL, with children in rural areas (OR = 4.66; p = 0.03) and lower grades (OR = 8.89; p = 0.05) facing greater challenges. Multiple regression analysis revealed a significant relationship between the self-distraction and physical component summary score (p = 0.01). Self-distraction (p = 0.01) and the acceptance coping strategy (p = 0.02) had a notable effect on the mental summary score of SF-12 scores of children with hearing loss.

Conclusion

This study concluded that children with hearing impairment showed poor quality of life and these children use maladaptive coping strategies to combat with the stress caused by hearing loss. Early detection, community awareness, and customized support programs are crucial to enhancing the QOL of children with hearing loss and minimizing the condition's long-term impact.

Parent-Child Agreement on Fatigue in Pediatric Otolaryngology Patients

Objectives

To investigate parent-child agreement on fatigue reporting in pediatric otolaryngology patients and whether agreement might vary by diagnosis and other patient factors.

Study Design

Cross-sectional survey.

Methods

Patients ages 5-18 years old being evaluated for hearing loss (HL) or obstructive sleep apnea (OSA) were recruited from a pediatric otolaryngology clinic and sleep center. Children and parents completed the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS).

Results

Responses of 42 patients with HL, 49 with OSA, 10 with sleep-disordered breathing (SDB), and 34 controls were analyzed. Parent and child PedsQL MFS scores were strongly correlated (Pearson r > 0.7) across groups with few exceptions. Only the median child-parent score differences for general domain score in the SDB group (12.5; 95% CI 2.08 to 22.9), and total score (7.41; 95% CI -0.69 to 25.7) and general domain score (11.5; 95% CI 2.08 to 27.1) in the developmental delay group met clinical significance thresholds. Wide confidence intervals prevented definitive conclusions regarding clinical significance. A pattern of decreased parent-child score correlations was observed in children reported to have delays. Weak (±0.1 to ±0.4) to moderate (±0.4 to ±0.69) correlations were observed for total score, general domain score, and cognitive domain score for children with reported developmental/speech/language delay.

Conclusion

Overall, the parent-proxy PedsQL MFS demonstrates strong agreement with self-reports for pediatric otolaryngology patients being evaluated for HL and OSA. However, parent-child score discrepancies within specific patient groups, especially children whose parents reported speech/developmental/language delays, emphasize the importance of administering self-reports when possible.

Level of Evidence

3.

Long-term clinical and audiometric outcomes after the implantation of piezoelectric bone conduction devices in children: a prospective cohort study

BACKGROUND

Bone conduction devices are hearing assistive devices that are used in many children who have conductive hearing loss, mixed hearing loss or single sided deafness. The aim of this study is to assess long-term outcomes of children who underwent piezoelectric bone conductive device implantation.

METHOD

A prospective cohort of children who underwent Osia system implantation (OSI200) between the period of Jan 2021 and December 2022. The main Outcome measures were; Long-term complications, hearing thresholds, speech discrimination, sound localization and quality of life.

RESULTS

25 children were implanted with 27 devices. The median surgical time 39 min. 6 children had single sided deafness, 21 ears had conductive hearing loss due to microtia/canal atresia (20 ears) or chronic ear disease (1 ear). None of the patients had any major adverse events. In children with conductive hearing loss, the median threshold of improvement was 37.5 dB. All patients reported significant improvement of their auditory function. Aided thresholds were best at 1 kHz (median 20 dB HL). Recorded gains were measured up 8000 Hz reflecting good auditory performance even at high frequencies. Speech Discrimination when using the Osia was 89% and self-reported hearing and quality of life by participants improved in all domains assessed.

CONCLUSION

Osia system is a safe and effective solution to restore hearing without any major long term complications. It provides auditory benefits that covers a wide range of frequencies. Children had significant improvement in their ability to sound localize as well as QoL. Osia surgery can be performed in a routine day surgery setting safely in children.

The use of hearing devices for children with persistent otitis media with effusion: a scoping review

OBJECTIVE

The aim of this scoping review was to summarise the current evidence on the use of air and bone conduction hearing devices for children with persistent OME.

DESIGN

A scoping review was conducted and online databases were used to search for peer review evidence. The review method followed Preferred Reporting Items for Systematic Reviews and Meta-analyses for scoping reviews - PRISMA-ScR.

STUDY SAMPLE

Children (<18 years) with persistent otitis media with effusion.

RESULTS

Database searches initially yielded 1490 articles. After abstract screening and full text review (n = 917), 5 articles were included for analysis. Definitive conclusions could not be drawn due to the paucity and low quality of the data, as well as the evident bias present. The limited qualitative data suggests that most participants appeared to benefit from their hearing devices, with high levels of parental satisfaction. Some negative effects associated with device use were identified, with reports of children feeling self-conscious and experiencing teasing.

CONCLUSIONS

A subjective consensus indicated that hearing devices provided benefit for children with persistent OME. Significant gaps in the evidence remain due to the limited availability of data. Further research is required to determine the best outcome measures, and to compare OME management strategies.

Auditory complications among childhood cancer survivors and health-related quality of life: a PanCareLIFE study

PURPOSE

Auditory complications are potential side effects from childhood cancer treatment. Yet, limited evidence exists about the impact of auditory complications-particularly tinnitus-on health-related quality of life (HRQoL) among childhood cancer survivors (CCS). We determined the prevalence of hearing loss and tinnitus in the European PanCareLIFE cohort of CCS and examined its effect on HRQoL.

METHODS

We included CCS from four European countries who were diagnosed at age ≤ 18 years; survived ≥ 5 years; and aged 25-44 years at study. We assessed HRQoL (Short Form 36), hearing loss, and tinnitus using questionnaires. We used multivariable linear regression to examine associations between these two auditory complications and HRQoL adjusting for socio-demographic and clinical factors.

RESULTS

Our study population consisted of 6,318 CCS (53% female; median age at cancer diagnosis 9 years interquartile range [IQR] 5-13 years) with median age at survey of 31 years (IQR 28-35 years). Prevalence was 7.5% (476/6,318; confidence interval [CI]: 6.9-8.2) for hearing loss and 7.6% (127/1,668; CI: 6.4-9.0) for tinnitus. CCS with hearing loss had impaired physical (coefficient [coef.] -4.3, CI: -7.0 to -1.6) and mental (coef. -3.2, CI: -5.5 to -0.8) HRQoL when compared with CCS with normal hearing. Tinnitus was associated with impaired physical (coef. -8.2, CI: -11.8 to -4.7) and mental (coef. -5.9, CI: -8.8 to -3.1) HRQoL.

CONCLUSION

We observed reduced HRQoL among CCS with hearing loss and tinnitus. Our findings indicate timely treatment of hearing loss and tinnitus may contribute to quality of life of survivors.

IMPLICATIONS FOR CANCER SURVIVORS

CCS who experience auditory complications should be counseled about possible therapeutic and supportive measures during follow-up care.

Development and assessment of the health-related quality of life scale for children with hearing loss in China

BACKGROUND

Hearing loss significantly affects children's lives; however, the health-related quality of life (QoL) of children with this disability is not well measured. We sought to develop a reliable and valid measure of health-related QoL in children with hearing loss.

METHODS

We constructed a conceptual framework to assess the QoL of children with hearing loss based on the Pediatric Quality of Life Inventory™ Version 4.0 child quality of life scale and World Health Organization Quality of Life Brief Version disability general version. The item pool was generated through two rounds of the Delphi method and subsequent group discussions. Subsequently, both a pre-survey and a formal survey were administered across eight hospitals and nine special education schools located in Shanxi and Hebei Province, China. The process of selecting items was grounded in classical test theory and item response theory. Ultimately, we assessed the reliability and validity of the QoL Scale designed for children with hearing loss in China.x` RESULTS: The final health-related QoL scale for children with hearing loss (HRQOL-CHL) included 37 items, 6 domains, and 8 subdomains. Reliability assessment encompassed Cronbach's alpha coefficient, split-half reliability, and retest reliability measures. Specifically, for the entire scale, Cronbach's alpha yielded a coefficient of 0.755, binary reliability of 0.796, and retest reliability of 0. 931. The validity findings indicated that the scale performed as anticipated. Both exploratory factor analysis and confirmatory factor analysis demonstrated that this multidimensional scale was well-suited for assessing children with hearing loss, demonstrating a superior fit.

CONCLUSIONS

The HRQOL-CHL exhibits positive reliability, validity, and feasibility, which makes it an efficient QoL assessment tool for children with hearing loss in China.

Associated factors and outcomes for quality of life in children receiving cochlear implantation before seven years of age

PURPOSE

To evaluate the relationship of cochlear implant-related factors with quality of life (QOL) outcomes in pediatric cochlear implantation (CI) recipients.

METHOD

In this cross-sectional study, data from 146 children who received CI before 7 years of age were collected. QOL was measured using the Children using Hearing Implants Quality of Life (CuHI-QoL) questionnaire. Auditory and language abilities were measured using categories of auditory performance II(CAP-II) scale and speech intelligibility rating (SIR) scale. The reliability and validity of the CuHI-QOL scale were tested using internal consistency tests and correlation analysis, respectively. Bivariate correlations were used to compare CuHI-QOL scores and educational placements to cochlear implant-related factors. QOL scores were further compared using ANOVA in different groups based on age at CI with different durations of implant use.

RESULTS

The mean total CuHI-QOL scores was 60.13 (SD 8.97). The Cronbach's alpha of overall CuHI-QOL scale was 0.820. The CuHI-QOL total score was strongly to moderately correlated with CAP score (r = 0.542), SIR score (r = 0.545), duration of implant use (r = 0.403), and educational placement (r = 0.478). ANOVA showed the CuHI-QOL scores after 5 years post-CI were higher than those less than 2 years post-CI in children implanted ≤ 3 years of age.

CONCLUSIONS

Good QOL could be obtained for children with CI and were significantly associated with young age at implantation, good auditory and speech abilities, speech rehabilitation training pre-CI, long duration of cochlear implant use, and mainstream educational placement.

Translation and validation of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire for preschool children in Dutch

OBJECTIVE

Early diagnosis, intervention and consistent follow-up of hearing loss is of great importance in children, given the broad impact of untreated childhood hearing loss. Currently, no hearing-specific QOL proxy questionnaire exists for preschool children with hearing loss in the Dutch language. Therefore, the aim of this study was to translate and validate the Preschool HEAR-QL questionnaire into Dutch.

METHODS

Translation was conducted according the forward-backward procedure. Parents or caregivers of 60 normal-hearing children and 50 children with bilateral hearing loss aged 2-6 years old were invited to digitally complete the questionnaire.

RESULTS

The Preschool HEAR-QL questionnaire showed good discriminant validity between the normal-hearing and the hearing loss group, for its total score and some subscales. We concluded satisfying internal consistency given Cronbach's alpha values being above 0.70, nearly all alpha if item deleted values approaching the overall values, and item-subscale correlations above 0.30. Test-retest reliability was satisfying with all intraclass correlation coefficients being greater than 0.70.

CONCLUSION

This Dutch hearing-specific QOL proxy questionnaire can play an important role in the management and follow-up of early childhood hearing loss in Dutch health care and hearing centers. Future research on clinical data will further verify its utility in clinical practice.

Deaf adolescents' quality of life: a questionnaire in Italian Sign Language

For some deaf people, sign language is the preferred language, the one in which they feel most comfortable. However, there are very few assessment tools developed or adapted for sign languages. The aim of this study was to translate and adapt in Italian Sign Language (LIS) the Italian version of the Youth Quality of Life Instrument-Deaf and Hard of Hearing Module (YQOL-DHH). The YQOL-DHH is a questionnaire assessing health-related quality of life in young deaf people. The guidelines provided by the authors of the original version were followed. Further controls and changes were made to take into account variability in signers' linguistic skills. This work and availability of the YQOL-DHH questionnaire in LIS, in addition to the Italian version, will ensure accessibility for Italian deaf adolescents.

Reliability of the Unilateral Hearing Loss in Youth Instrument for Children With Single-Sided Deafness

PURPOSE

While general practice parameter recommendations for children with unilateral hearing loss or single-sided deafness (SSD) have been published, clinically utilized subjective instruments specifically designed to assess this population are scarce. Treatment options are evaluated using audiometric data, speech perception data, and quality of life instruments. The Unilateral Hearing Loss in Youth (uniHELO) is a subjective assessment instrument that aims to evaluate the listening challenges in this population, but it has not yet been studied in a clinical setting. This study examined the reliability of the uniHELO among children with SSD.

METHOD

This was a prospective within-subject study. Nine patients with SSD, aged 8-14 years, were enrolled. Participants had not used a personal hearing device for at least 6 months prior to enrollment. The uniHELO instrument was administered at two clinic visits separated by 3-4 weeks. For comparison, the Pediatric and Parent Speech, Spatial, and Qualities of Hearing Scale (SSQ) instruments were administered during the same visits.

RESULTS

uniHELO scores were not significantly different between the first and second visits. The correlations of scale scores over time were: .96 for the uniHELO, which suggests excellent test-retest reliability; .84 for the Parent SSQ, which also suggests excellent test-retest reliability; and .27 for the Pediatric SSQ, which suggests poor test-retest reliability compared to the Parent SSQ and uniHELO.

CONCLUSIONS

Within-subject scale uniHELO scores between clinic visits showed excellent test-retest reliability across items. The test-retest reliability scores for the uniHELO were also stronger than those for the Parent and Pediatric SSQ. These data support the use of the uniHELO to evaluate listening challenges in children with SSD.

The impact of hearing loss and cochlear implantation on the quality of life in children

BACKGROUND

This study evaluates the Quality of Life (QoL) in children with moderate to profound hearing impairments using cochlear implants (CIs), compared to those with normal hearing. It explores the impacts of hearing loss and the effectiveness of CIs in pediatric populations.

METHODS

Conducted at a tertiary care academic center, this cross-sectional study included children aged 13-18. Participants were divided into three groups: normal hearing, yet to be treated moderate or worse hearing loss (uHL), and CI users. Demographic data were collected, and the QoL was assessed using the Hearing Environments and Reflection of Quality of Life (HEAR-QL) questionnaire, with scores across various subdomains compared.

RESULTS

Of the 79 children meeting the inclusion criteria, 38 % had normal hearing, 29 % had at least moderate HL, and 33 % were CI users. Statistically significant differences in HEAR-QL scores were found among the groups. The normal hearing group reported the highest scores. In the subdomain of hearing circumstances and academic performance, CI users showed no significant difference from the normal hearing group, unlike those with untreated uHL who scored lower. However, in social interaction and emotional well-being subdomains, CI users' scores were lower than those of the normal hearing group but similar to the uHL group.

CONCLUSION

Children with CIs show comparable QoL in auditory capabilities to their normal hearing peers but experience significant challenges in psychosocial and emotional areas. This indicates that while CIs can improve hearing-related quality of life, they do not fully address the psychosocial impacts of hearing loss.

Self-reported Hearing Quality of Life for Adolescent Cochlear Implant Recipients: A Longitudinal Study

BACKGROUND

 Clinicians are increasingly interested in self-reported hearing-specific quality of life (HQoL) for cochlear implant (CI) recipients, including pediatric CI recipients.

PURPOSE

 (1) To compare HQoL of adolescent CI recipients to those of peers with typical hearing (TH); (2) to examine, longitudinally, HQoL for a set of CI recipients; and (3) to determine the effects of child, demographic, audiological, speech perception, and language variables on adolescent HQoL.

RESEARCH DESIGN

 Hearing Environments and Reflections on Quality of Life (HEARQL) questionnaires were completed by children with CIs at elementary (HEARQL-26) and adolescent (HEARQL-28) ages.

STUDY SAMPLE

 Eighty CI recipients and 21 children with TH.

DATA COLLECTION AND ANALYSIS

 HEARQL-28 scores for the CI and TH groups were compared using nonparametric tests. Regression models were used to examine longitudinal results and to explore predictor variables for adolescent CI participants' HEARQL-28 scores.

RESULTS

 HEARQL-28 scores for CI participants were lower than those of peers with TH. For both CI and TH adolescents, the HEARQL subscale with the lowest score is "Hearing Situations." CI participants' HEARQL scores at elementary age were not significantly correlated with scores at adolescence. Over 70% of unexplained variance remains even after inclusion of variables with established contributions to traditional CI benefit.

CONCLUSIONS

 Self-reported HEARQL scores are largely unexplained for pediatric CI recipients; multidisciplinary explorations of other sources of variance, such as social, emotional, and psychosocial factors, should be pursued.

The Validity and Reliability of the Turkish Version of Preschool Hearing Environments and Reflection on Quality of Life Questionnaire

PURPOSE

The purpose of this study was to assess preschool children's hearing-related quality of life and to introduce the scale, originally titled "Preschool Hearing Environments and Reflections on Quality of Life Questionnaire" (Preschool HEAR-QL), to the literature through Turkish adaption, validity, and reliability analyses.

METHOD

Our study included 210 children aged 2-6 years: 110 with hearing loss (56 cochlear implant users and 54 hearing aid users) and 100 with normal hearing. Demographic data were collected and then the Preschool HEAR-QL, which was translated into Turkish, was administered twice at 15-day intervals. Confirmatory factor analysis was used to determine whether the factor structure found in the original scale development study was confirmed in our sample (construct validity). Cronbach's alpha, intraclass correlation scores, and the test-retest method were used to assess the scale's reliability as the findings were analyzed using paired samples t tests.

RESULTS

The children with hearing loss had lower scores than their normal-hearing peers, and the difference was significant in the subdomains of behavior and attention, hearing environments, and communication. The subscale of the Preschool Period Listening Environments and their Reflections on Quality of Life Scale consists of 23 items, and Cronbach's alpha value was found as 0.922 in the first application and 0.926 in the second application (high reliability). In the model established for validity analysis, χ2/df = 2.156, root-mean-square error of approximation = 0.074, standard root-mean-square residual = 0.078, goodness-of-fit index = 0.830, adjusted goodness-of-fit index = 0.789, comparative fit index = 0.895, and Tucker-Lewis index = 0.881 (good model fit). In terms of test-retest reliability, the correlation between the two measurements was 0.837, and there was no statistical difference between the test-retest scores (p = .15).

CONCLUSION

The Turkish version of the Preschool HEAR-QL scale was proven to be a valid and reliable scale for assessing the hearing-related quality of life of children aged 2-6 years.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25236949.

[Assessment of auditory perception of children with single-sided deafness after cochlear implantation]

Unilateral deafness will lead to the decline of children's speech recognition rate, language development retardation and spatial positioning ability, which will have many adverse effects on children's life and study. Cochlear implantation can help children rebuild binaural hearing, and systematic audiological evaluation after operation is particularly important for clinicians to evaluate the hearing recovery of children. In this study, a variety of commonly used audiological evaluation, testing processes and methods after cochlear implantation in children with unilateral deafness are described in detail, and the related research status and results are summarized.

Assessing quality of life in childhood cancer survivors at risk for hearing loss: a comparison of HEAR-QL and PROMIS measures

Background

Childhood cancer survivors (CCS) exposed to platinum chemotherapy are at an increased risk of developing hearing loss and reporting decreased quality of life (QOL). This study compared two QOL measures; one developed for children with hearing loss, The Hearing Environments and Refection on Quality of Life (HEAR-QL), and one validated in CCS, the Patient-Reported Outcomes Measurement Information System (PROMIS), to assess their ability to evaluate QOL deficits in this population.

Methods

Subject eligibility were restricted to CCS exposed to platinum-based chemotherapy but who were free of known risk factors for cognitive impairment, (non-central nervous system tumor, no cranial radiation, or intrathecal chemotherapy). Participants had to be between 8-17 years, have completed anti-cancer therapy for at least 6 months, and have an audiogram within 1 year, Participants completed the HEAR-QL-26 (7-12 years) or the HEAR-QL-28 (13-18 years) and the PROMIS. Independent samples and/or one sample T-tests were utilized to compare participants with normal hearing and hearing loss, and to compare outcome measures to normative HEAR-QL and PROMIS data. Non-parametric correlations were utilized to evaluate the relationship between QOL and demographic and medical variables, and QOL and severity of hearing loss.

Results

Fifty-four CCS were evaluable. The mean age was 12.0 years. Twenty-eight participants (51.9%) received cisplatin, 30 (55.6%) carboplatin, and 4 (7.4%) received both. Twenty participants (37%) demonstrated hearing loss. Participants with hearing loss scored significantly lower on the HEAR-QL than those with normal hearing (mean: 70.3, SD: 21.7, vs mean: 88.0, SD: 9.3, p =.004 for the HEAR-QL-26; mean: 84.7, SD: 10.2 vs mean: 94.8, SD: 3.4, p =.040 for the HEAR-QL-28). Participants with normal hearing scored significantly lower on the HEAR-QL-26 than the normative mean (mean: 88, SD: 9.3, normative mean: 98, SD: 5, p =.000). The PROMIS failed to identify any differences in QOL between participants based on hearing status, or when compared to the normative mean.

Conclusion

The HEAR-QL was more sensitive than the PROMIS in identifying QOL deficits in CCS at risk for hearing loss. The HEAR-QL should be considered in studies seeking to improve the QOL of CCS with hearing loss.

Long-Term Outcome of Cochlear Implantation in Children With Congenital, Perilingual, and Postlingual Single-Sided Deafness

OBJECTIVES

We investigated the long-term outcomes of children with single-sided deafness (SSD) after cochlear implant (CI) surgery, during and after rehabilitation, and compared the results of children with congenital, perilingual, and postlingual SSD. We evaluated the impact of SSD at age at onset and duration of deafness on their performance.

DESIGN

Thirty-six children with SSD treated with CI participated in the study: 20 had congenital, seven perilingual (defined: >0 to 4 years), and nine had postlingual deafness (defined as >4 years of age). Their outcome with CI were measured on both subjective and objective scales: duration of device use, speech intelligibility in noise and in quiet, bilateral hearing and localization ability, quality of life and hearing, presence and loudness of tinnitus, and hearing ability of the better hearing ear.

RESULTS

After a mean follow-up time of 4.75 years, 32 of the 36 children used their CI on a regular basis. The remaining four children were nonusers. These children had congenital SSD and were older than three years at the time of CI surgery. Overall, for congenital/perilingual and postlingual SSD, speech intelligibility in noise and the Speech, Spatial and Qualities of Hearing Scale (SSQ) speech subscore were significantly improved, as were their subjective and objective localization ability and hearing-related quality of life. Children with postlingual SSD benefited from the CI with regard to speech intelligibility, SSQ speech/spatial/total score, and localization error, and children with congenital SSD showed better results with a short duration of deafness of less than 3 years compared with those with a longer deafness period.

CONCLUSIONS

Cochlear implantation is a successful treatment for children with congenital/perilingual or postlingual SSD. Results largely differed with respect to the onset and duration of deafness, and better outcomes were achieved by children with postlingual SSD and with a short duration of deafness. Our data also confirmed that children with congenital SSD should be implanted with a CI within three years of age.

Fatigue and Quality of Life in Children with Hearing Loss or Obstructive Sleep Apnea

OBJECTIVE

To investigate the fatigue levels of children with hearing loss (HL) and obstructive sleep apnea (OSA), hypothesizing that the fatigue experienced by children with HL is under-recognized.

STUDY DESIGN

Cross-sectional survey.

METHODS

We identified children aged 2-18 with HL, OSA, sleep-disordered breathing (SDB), and controls from a pediatric otolaryngology clinic and sleep center. Children and/or parents completed the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS), Hearing Environments And Reflection on Quality of Life (HEAR-QL), and OSA-18.

RESULTS

Responses of 50 children with HL, 79 with OSA, and 18 with SDB were compared with those of 49 recruited controls (RC) and literature controls (LC). Children with HL or OSA had higher fatigue than controls in the PedsQL MFS self-reported (HL 65.4, OSA 54.7, RC 71.8, LC 80.5, p < 0.001) and parent-reported (HL 64.6, OSA 59.3, RC 75.2, LC 89.6, p < 0.001). Children with HL had Cognitive Fatigue similar to that of children with OSA (self 60.4 vs. 49.5, p = 0.170; parent 56.0 vs. 56.7, p = 0.998), though with decreased Sleep/Rest Fatigue (self 67.8 vs. 56.3, p = 0.033; parent 69.8 vs. 57.5, p = 0.001). Children with HL or OSA had lower disease-related quality of life (QOL) than controls in the HEAR-QL and OSA-18, respectively. Stratification with disease severity revealed no differences in fatigue.

CONCLUSION

Children with HL or OSA experience higher fatigue and lower QOL than controls. Similar Cognitive Fatigue in both groups suggests under-recognized fatigue in children with HL.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:443-451, 2024.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review

OBJECTIVES

Social determinants of health (SDOH) (healthcare access and quality, education access and quality, socioeconomic status, social and cultural context, neighborhood and built environment) ( Healthy People 2030 ) have been shown to impact a wide range of health-related outcomes and access to care. Given the medical and nonmedical costs associated with children with unilateral hearing loss (UHL), the varied insurance coverage for hearing healthcare services, and the differences in hearing aid utilization rates between children of different sociodemographic classes, the sociodemographic information of children with UHL enrolled in research studies should be collected to ensure the generalizability of hearing healthcare interventions. Therefore, the objective of this scoping review is to assess the reporting of SDOH data for participants in studies of pediatric UHL and its comparison to population trends.

DESIGN

Two searches of published literature were conducted by a qualified medical librarian. Two reviewers then evaluated all candidate articles. Study inclusion parameters were from 2010 to present, peer-reviewed studies with prospective study design, and participant population including children (age 0 to 18 years old) with UHL.

RESULTS

Two literature searches using PubMed Medline and Embase found 442 and 3058 studies each for review. After abstract and paper review, 87 studies were included in final qualitative review, with 22 of these studies reporting race distribution of participants, 15 reporting insurance status or family income, and 12 reporting the maternal education level.

CONCLUSIONS

Sociodemographic data are not commonly reported in research studies of children with UHL. In reported samples, research participants are more likely to have private insurance and higher family income compared with overall population distribution. These demographic biases may affect the generalizability of study results to all children with UHL. Further evaluation is warranted to evaluate whether participant recruitment affects outcomes that reflect the overall population.

Sociodemographic Disparities and Hearing-Related Quality of Life in Children With Hearing Loss

This cohort study assesses the association of sociodemographic differences with quality of life in deaf and hard-of-hearing children and adolescents in the US.

Psychosocial and Health-Related Experiences of Individuals With Microtia and Craniofacial Microsomia and Their Families: Narrative Review Over 2 Decades

This paper describes 20 years of microtia and craniofacial microsomia (CFM) psychosocial and healthcare studies and suggests directions for clinical care and research.

A narrative review of papers January 2000 to July 2021 related to psychosocial and healthcare experiences of individuals with microtia and CFM and their families.

Studies (N = 64) were mainly cross-sectional (69%), included a range of standardized measures (64%), and were with European (31%), American (27%), or multinational (23%) samples. Data were generally collected from both patients and caregivers (38%) or patient self-report (35%). Sample sizes were 11 to 25 (21%), 26 to 50 (19%), 51 to 100 (22%), or over 100 (38%). Studies addressed 5 primary topics: (1) Healthcare Experiences, including Medical Care, Hearing Loss/Amplification, Diagnostic Experiences, and Information Preferences; (2) Psychosocial Experiences, including Teasing, Behavioral Adjustment, Psychosocial Support, and Public Perception; (3) Neurocognitive Functioning and Academic Assistance; (4) Pre- and Post-Operative Psychosocial Outcomes of Ear Reconstruction/Canaloplasty; and (5) Quality of Life and Patient Satisfaction.

Care involved multiple specialties and was often experienced as stressful starting at diagnosis. Psychosocial and neurocognitive functioning were generally in the average range, with possible risk for social and language concerns. Coping and resiliency were described into adulthood. Satisfaction and positive benefit of ear reconstruction/canaloplasty were high. Care recommendations include increasing: hearing amplification use, microtia and CFM knowledge among providers, efficient treatment coordination, psychosocial support, academic assistance, and advances to minimize surgical scarring. This broad literature overview informs clinical practice and research to improve psychosocial outcomes.

Community Perspectives on Hearing Loss in Rural Alaska

OBJECTIVES

The aim of this study is to present an explanatory model of hearing loss in the Bering Strait region of Alaska in order to contextualize the results of a cluster randomized trial and propose implications for regional hearing-related health care.

DESIGN

To promote ecological validity, or the generalizability of trial findings to real world experiences, qualitative methods (focus groups and interviews) were used within a mixed methods cluster randomized trial evaluating school hearing screening and follow-up processes in 15 communities in the Bering Strait region of Alaska. Focus groups were held between April and August 2017, and semistructured interviews were conducted between December 2018 and August 2019. Convenience sampling was used for six of the 11 focus groups to capture broad community feedback. Purposive sampling was used for the remaining five focus groups and for all interviews to capture a variety of experiences with hearing loss. Audio recordings of focus groups and interviews were transcribed, and both notes and transcripts were deidentified. All notes and transcripts were included in the analysis. The constant comparative method was used to develop a codebook by iteratively moving between transcripts and preliminary themes. Researchers then used this codebook to code data from all focus groups and interviews using qualitative analysis software (NVIVO 12, QSR International) and conducted thematic analyses to distill the findings presented in this article.

RESULTS

Participants in focus groups (n = 116) and interviews (n = 101) shared perspectives in three domains: etiology, impact, and treatment of hearing loss. Regarding etiology, participants emphasized noise-induced hearing loss but also discussed infection-related hearing loss and various causes of ear infections. Participants described the impact of hearing loss on subsistence activities, while also detailing social, academic, and economic consequences. Participants described burdensome treatment pathways that are repetitive and often travel and time intensive. Communication breakdowns within these pathways were also described. Some participants spoke positively of increased access via onsite hearing health care services in "field clinics" as well as via telemedicine services. Others described weaknesses in these processes (infrequent field clinics and communication delays in telemedicine care pathways). Participants also described home remedies and stigma surrounding the treatment for hearing loss.

CONCLUSIONS

Patient-centered health care requires an understanding of context. Explanatory models of illness are context-specific ways in which patients and their networks perceive and describe the experience of an illness or disability. In this study, we documented explanatory models of hearing loss to foster ecological validity and better understand the relevance of research findings to real-life hearing-related experiences. These findings suggest several areas that should be addressed in future implementation of hearing health care interventions elsewhere in rural Alaska, including management of repetitious treatments, awareness of infection-mediated hearing loss, mistrust, and communication breakdowns. For hearing-related health care in this region, these findings suggest localized recommendations for approaches for prevention and treatment. For community-based hearing research, this study offers an example of how qualitative methods can be used to generate ecologically valid (i.e., contextually grounded) findings.

Cochlear Implantation and Educational and Quality-of-Life Outcomes in Adolescence

Importance

Cochlear implants (CIs) have been shown to be effective in improving auditory skills and speech and language development. However, less is known about the long-term outcomes of CIs on educational functioning or quality of life.

Objective

To evaluate long-term educational outcomes and quality of life in adolescents over 13 years postimplantation.

Design, Setting, and Participants

This longitudinal cohort study included 188 children with bilateral severe to profound hearing loss with CIs from the Childhood Development After Cochlear Implantation (CDaCI) study from hospital-based CI programs; a cohort of 340 children with severe to profound hearing loss without CIs from a nationally representative survey (National Longitudinal Transition Study-2; NLTS-2), and results from the literature of comparable children without CIs.

Exposure(s)

Cochlear implantation (early and late).

Main Outcomes and Measures

Adolescent performance on measures of academic achievement (Woodcock Johnson), language (Comprehensive Assessment of Spoken Language), and quality of life (Pediatric Quality of Life Inventory, Youth Quality of Life Instrument-Deaf and Hard of Hearing).

Results

The CDaCI cohort included 188 children, 136 of whom completed the wave 3 postimplantation follow-up visits (77 [55%] female) with CIs; mean [SD] age was 11.47 [1.27] years. The NLTS-2 cohort included 340 children (50% female) with severe to profound hearing loss without CIs. Children with CIs had better academic performance compared with children without CIs with similar levels of hearing loss. The largest benefits were seen for children who received implants early (prior to age 18 months), who performed at or above age and gender norms for language and academic achievement. Similarly, adolescents with CIs reported better quality of life on the Pediatric Quality of Life Inventory compared with children without CIs. On a condition-specific measure (Youth Quality of Life Instrument-Deaf and Hard of Hearing), children who received implants early scored higher across all 3 domains than comparisons without CIs.

Conclusions and Relevance

To our knowledge, this is the first study to evaluate long-term educational outcomes and quality of life in adolescents using CIs. This longitudinal cohort study showed better outcomes of CIs in terms of language, academic performance, and quality of life. While the greatest benefits were observed for children who received implants before age 18 months, benefits were also noted for children who received implants later, providing evidence that children with severe to profound hearing loss with CIs can achieve at or above expected levels compared with hearing peers.

[Analysis of rehabilitation effects of cochlear implantation in elderly patients with prelingual deafness]

Objective:The auditory and speech rehabilitation effects were assessed by the Categories of Auditory Performance（CAP） and the speech intelligibility rating scale（SIR） after cochlear implantation（CI） in prelingually elderly patients by telephone follow-up or face-to-face conversation. Methods:The clinical data of the prelingually deaf patients who underwent unilateral CI in the Department of Otorhinolaryngology and Head and Neck Surgery, Shanxi People's Hospital, from December 2016 to December 2021 were collected. Thirty-eight patients were divided into Group A（SIR 1, 17 cases）, Group B（SIR 2, 10 cases） and Group C（SIR 3, 11 cases） according to the preoperative SIR Score. Nineteen patients with post-lingual hearing impairment were selected as the control group（Group D, 19 cases）. The effects of hearing and speech rehabilitation were evaluated using CAP and SIR Scores before surgery, 6 months after startup, and 1 year after startup. Results:There were no significant differences in CAP scores among the three groups of patients with prelingually deaf patients at 6 months and 1 year after startup（P>0.05）, but there were significant differences between group A and group D at 6 months and 1 year after startup（P<0.05）; the SIR Score of group A had statistical difference before surgery and 6 months after startup（P<0.05）, group B had statistical difference before surgery and 1 year after startup（P<0.05）, and group C and D had no statistical difference before surgery and 6 months and 1 year after startup, respectively（P>0.05）. Conclusion:For the prelingually deaf elderly patients, hearing will develop rapidly 6 months after startup, and the effect of postoperative auditory rehabilitation was positively correlated with the preoperative speech ability. In the aspect of speech, the prelingually dear elderly patients who have poor preoperative speech ability could benefit more from CI early after surgery. CI is not contraindicated in prelingually deaf elderly patients, even those with poor preoperative speech function.

Translation and Validation of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) Questionnaire for Children and Adolescents in Arabic

Background There are numerous quality-of-life (QoL) assessment tools available; however, only a few are designed specifically for children with chronic conditions. Among these assessment tools are the Hearing Environments and Reflection on QoL questionnaires for children (HEAR-QL26, HEAR-Q28) developed by Washington University. Unfortunately, there are no other tools that assess hearing loss, and none of them are in Arabic. This paper aims to adapt the HEAR-QL to Arabic and provide an accessible method of measuring the QoL of children with hearing loss in our Arabic-speaking populations. Methodology An independent medical translator translated the HEAR-QL26 and HEAR-QL28 into Arabic. The translations were then examined by two bilingual, native Arabic-speaking otolaryngologists who modified the inadequate questions. Back-translation of the Arabic version into English was subsequently performed by an independent translator. Intra-rater reliability was tested for each of HEAR-QL26 and HEAR-QL28 using 10 participants for each survey, where the participants answered the surveys twice with a period of two weeks between them. A pilot study was conducted which had a total of 40 participants divided equally between the two surveys where each group had an equal number of hearing participants and participants with hearing loss. Results Both HEAR-QL26 and HEAR-QL28 were validated with an overall intra-rater reliability of 88.85% and 87.86% respectively. In the pilot study, the HEAR-QL26 participants with normal hearing scored a median of 2437.5, while the participants with hearing loss scored a median of 1837.5 (p = 0.001). Moreover, HEAR-QL28 participants had a median score of 2725 among participants with normal hearing and 1725 for participants with hearing loss (p = 0.001). Conclusion HEAR-QL is a well-established QoL in children with hearing loss. The validated Arabic adaptation can now be used to measure deafness in Arabic-speaking children.

Health-Related Quality of Life in Children With Unilateral Sensorineural Hearing Loss Following Cochlear Implantation

OBJECTIVE

Evaluate health-related quality of life (HR-QOL) benefits with cochlear implantation (CI) in children with unilateral sensorineural hearing loss (USNHL) versus bilateral sensorineural hearing loss (BSNHL).

STUDY DESIGN

A cross-sectional survey of parents of children who underwent CI for USNHL and BSNHL.

SETTING

Tertiary care academic centers.

METHODS

The "Children with cochlear implants: parental perspectives" survey was administered. Parents rated responses on a 5-point Likert scale. Scores greater than 3.0 were considered favorable. Responses were recorded within 8 domains and groups were compared with respect to domain scores. Analysis of covariance models was used to compare groups while adjusting for age at implantation and duration of implant use.

RESULTS

There were 31 patients with USNHL and 27 patients with BSNHL. The average age of implantation in BSNHL patients was 1.9 and 6.7 years for USNHL. Parents of all children answered favorably in all domains. When adjusted for age at implantation and duration of implant use, parents of BSNHL children responded significantly more favorably only in 2 domains. When comparing patients with older age or prolonged duration of hearing loss in the USNHL cohort, there were favorable responses in all domains with no significant differences between groups.

CONCLUSION

There are HR-QOL benefits of CI in USNHL children; less pronounced favorable results were noted only in 2 domains when compared to BSNHL children. Benefits were noted with CI in USNHL children at an older age at implantation or prolonged duration of hearing loss. Therefore, these factors should not be absolute contraindications for CI in USNHL.

Most-Cited Patient-Reported Outcome Measures Within Otolaryngology-Revisiting the Minimal Clinically Important Difference: A Review

Importance

Patient-reported outcome measures (PROMs) allow clinicians and researchers to assess health-related information from a patient's perspective. These measures have been used more frequently over the last several decades, but an associated minimal clinically important difference (MCID) is needed to optimize their utility. This narrative review identified the top 100 most-cited otolaryngology-related PROM development and validation publications and assessed the presence and characteristics of the PROMs' associated MCID.

Observations

In this narrative review, a literature search in Scopus and Web of Science was conducted on June 29, 2022, using keywords related to PROM development and validation studies in otolaryngology and reference lists. Studies that met the definition of a PROM and assessed an otolaryngologic disorder or study population were included for full-text review. After full-text review of 188 articles, the top 100 most-cited PROM development and validation publications, resulting in 106 total PROMs, were chosen for review. A total of 39 (37%) of the identified PROMs had an associated MCID. Of those reporting an MCID, 14 (35.9%) used an anchor-based method, 12 (30.8%) used a distribution-based method, 10 (25.6%) used both, and 3 (7.7%) did not specify or used neither method. Rhinology had the greatest number of PROMs with an associated MCID (16 of 24, 66%), and pediatrics had the fewest (1 of 13, 7.7%). The median number of citations of PROMs with an MCID was higher than those without an MCID.

Conclusions and Relevance

The majority of the most-cited PROMs in otolaryngology lack an associated MCID. These data indicated that there are a multitude of PROMs that have been cited hundreds of times and used for decades without the ability to identify whether a particular change in score on the instrument is clinically meaningful. There is a need to determine and validate MCIDs for commonly used PROMs to aid clinical research and trial interpretation.

Hearing-related quality of life in children and adolescents in rural Alaska

Objective

This study evaluated the Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire in rural Alaska, including an addendum crafted through community feedback to reflect the local context. The objectives were to assess whether HEAR-QL score was inversely correlated with hearing loss and middle ear disease in an Alaska Native population.

Methods

The HEAR-QL questionnaires for children and adolescents were administered as part of a cluster randomized trial in rural Alaska from 2017 to 2019. Enrolled students completed an audiometric evaluation and HEAR-QL questionnaire on the same day. A cross-sectional evaluation of questionnaire data was utilized.

Results

A total of 733 children (ages 7-12 years) and 440 adolescents (ages ≥13 years) completed the questionnaire. Median HEAR-QL scores were similar among children with and without hearing loss (Kruskal-Wallis, p = .39); however, adolescent HEAR-QL scores significantly decreased with increasing hearing loss (p < .001). Median HEAR-QL scores were significantly lower in both children (p = .02) and adolescents (p < .001) with middle ear disease compared with those without. In both children and adolescents, the addendum scores were strongly correlated with total HEAR-QL score (ρSpearman = 0.72 and 0.69, respectively).

Conclusions

The expected negative association between hearing loss and HEAR-QL score was observed in adolescents. However, there was significant variability that could not be explained by hearing loss, and further investigation is warranted. The expected negative association was not observed in children. HEAR-QL scores were associated with middle ear disease in both children and adolescents, making it potentially valuable in populations where the prevalence of ear infections is high.

Level of Evidence

Level 2 Clinicaltrials.gov registration numbers: NCT03309553.

Translation and validation of the speech, spatial, and qualities of hearing scale (SSQ) and the hearing environments and reflection on quality of life (HEAR-QL) questionnaire for children and adolescents in Dutch

OBJECTIVE

To date, no hearing-specific self-report tool is available in Dutch to give insight into how deficits in auditory skills are experienced by a child in daily life or to examine the impact of hearing loss on children's quality of life. Therefore, we aimed to translate and validate the Speech, Spatial, and Qualities of Hearing Scale (SSQ) and the Hearing Environments and Reflection on Quality of Life (HEAR-QL) Questionnaire for children and adolescents into Dutch.

DESIGN

Translation of the questionnaires into Dutch was conducted by means of the forward-backward procedure. Participants were invited to complete the questionnaires digitally. We examined discriminant validity, internal consistency, and test-retest reliability.

STUDY SAMPLE

A total of 121 subjects between 7 and 18 years old were included, of which 54 normal hearing and 67 bilaterally hearing-impaired subjects. Hearing-impaired subjects were fitted with hearing aids, bone conductive devices and/or cochlear implants.

RESULTS

All questionnaires were shown to significantly discriminate between the normal hearing and the hearing-impaired group. Satisfying internal consistency and good test-retest reliability were found.

CONCLUSIONS

The Dutch SSQ and HEAR-QL questionnaires for children and adolescents appear to be valid and reliable self-report tools for management and follow-up of those with hearing loss.

Validity, Discriminative Ability, and Reliability of the Turkish Hearing-Related Quality of Life Questionnaire for Children and Adolescents

PURPOSE

The aim of this study was to translate the versions of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) into Turkish and investigate the validity and reliability of the Turkish 26-item HEAR-QL (HEAR-QL-26) for children and Turkish 28-item HEAR-QL (HEAR-QL-28) for adolescents.

METHOD

The protocol included translation into Turkish and linguistic adaptation. The HEAR-QL-26 and HEAR-QL-28, respectively, were administered to 249 children (130 with hearing loss, 119 without hearing loss) and 249 adolescents (140 with hearing loss, 109 without hearing loss) between the ages of 8 and 18 years. To determine the internal consistency (reliability) of the Turkish HEAR-QL scale, Cronbach's alpha coefficient (α) was calculated for the subcategories and the total score. We measured the construct validity of the Turkish HEAR-QL-26 and HEAR-QL-28 using Pearson r correlation coefficients comparing the Turkish HEAR-QL and the Turkish Child and Adolescent Quality of Life Scale (PedsQL).

RESULTS

The reliability for both children and adolescents (Cronbach's alpha = .973 for HEAR-QL-26 and .977 for HEAR-QL-28) was high, and test-retest reliability showed strong to excellent correlations (intraclass correlation coefficient = .980 and .979, respectively) for the total scores. In terms of known-group validity, the total HEAR-QL mean scores were lower for participants with hearing loss than for children/adolescents with normal hearing (p < .05). Confirmatory factor analysis showed that the number of original items was sufficient in the Turkish version. Both HEAR-QL versions provided a higher area under the curve (AUC = .984 and .972, respectively) than the PedsQL (AUC = .773 and .581, respectively).

CONCLUSION

The Turkish versions of the HEAR-QL-26 child and HEAR-QL-28 adolescent questionnaires are sensitive, reliable, and valid measurement tools to evaluate the hearing-related quality of life in children and adolescents aged between 8 and 18 years.

Subjective Fatigue in Children With Unaided and Aided Unilateral Hearing Loss

OBJECTIVES

Fatigue is frequently observed in children with chronic diseases and can affect the quality of life (QoL). However, research in children with unilateral hearing loss (UHL) is scarce. Subsequently, no studies investigated the effects of hearing aids on fatigue in children. This study investigates subjective fatigue and hearing-related QoL in children with UHL. Furthermore, it evaluates the influence of hearing aids, subject-specific factors, and respondent-type on subjective fatigue.

STUDY DESIGN

A cross-sectional study was conducted from June 2020 until September 2020 at the department of otorhinolaryngology in a tertiary referral center.

METHODS

The primary outcome was the difference in subjective fatigue and hearing-related QoL between children with unaided UHL, aided UHL, and normal hearing. Subjective fatigue and hearing-related QoL were measured using the Pediatric Quality of Life Inventory™ Multidimensional Fatigue Scale (PedsQL™-MFS) and Hearing Environments and Reflection on Quality of Life (HEAR-QL™) questionnaires.

RESULTS

Along with 36 aided children with UHL, 34 unaided and 36 normal-hearing children were included. Child reports revealed significantly more cognitive fatigue in children with aided UHL than children with normal hearing (median difference 12.5, P = .013). Parents reported more fatigue in children with UHL compared to normal-hearing siblings. Especially children with aided UHL seemed at increased risk for fatigue. Children with UHL scored lower on hearing-related QoL than children with normal hearing. No apparent differences were found in fatigue and QoL between children with unaided and aided UHL.

CONCLUSION

Children with unaided and even aided UHL seem to experience more subjective fatigue and lower hearing-related QoL than children with normal hearing. Prospective longitudinal studies are required to investigate the influence of hearing aids on fatigue and QoL in individual patients.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021 Laryngoscope, 133:189-198, 2023.

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants-not just cochlear implant-specific benefits-Perspective

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8-9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Hearing-related quality of life assessment of pediatric cochlear implant users with inner ear malformations

OBJECTIVES

To assess the quality of life (QoL) in child and adolescent cochlear implant users with inner ear malformations (IEM) and to compare their outcomes to their cochlear implant using peers with normal inner ear structures.

METHODS

The present sample consisted of 100 children (45 with IEM, 55 without IEM) and 100 adolescents (46 with IEM, 54 without IEM). The following QoL questionnaires were used to assess the hearing-related QoL: The Hearing Environments and Reflection on Quality of Life 26 (HEAR-QL-26 for children between 7 and 12 years of age) and HEAR-QL-28 (for adolescents between 13 and 18 years of age). Both questionnaires were based on a 5-points Likert scale from 0 to 4, with higher scores indicating a better perception of QoL. The scores were converted to percentage values (never = 100, almost never = 75, sometimes = 50, often = 25, almost always = 0).

RESULTS

For the patients with IEM, mean scores from the HEAR-QL-26 and HEAR-QL-28 were 50.4 (SD = 18.9) and 54.5 (SD = 19.6), respectively. For the patients without IEM, mean scores from the HEAR-QL-26 and HEAR-QL-28 were 72.7 (SD = 18.0) and 65.0 (SD = 19.1), respectively. For both child and adolescent subgroups, statistically significant differences were observed between QoL scores from patients with and without IEM (p < 0.001). There were no statistically significant effects of the malformation type on the QoL findings (p ≥ 0.05).

CONCLUSION

Child and adolescent cochlear implant users with IEM had significantly lower scores on validated HEAR-QL versions in comparison to their implanted peers without IEM.

Mobile health school screening and telemedicine referral to improve access to specialty care in rural Alaska: a cluster- randomised controlled trial

BACKGROUND

School-based programmes, including hearing screening, provide essential preventive services for rural children. However, minimal evidence on screening methodologies, loss to follow-up, and scarcity of specialists for subsequent care compound rural health disparities. We hypothesised telemedicine specialty referral would improve time to follow-up for school hearing screening compared with standard primary care referral.

METHODS

In this cluster-randomised controlled trial conducted in 15 rural Alaskan communities, USA, we randomised communities to telemedicine specialty referral (intervention) or standard primary care referral (control) for school hearing screening. All children (K-12; aged 4-21 years) enrolled in Bering Straight School District were eligible. Community randomisation occurred within four strata using location and school size. Participants were masked to group allocation until screening day, and assessors were masked throughout data collection. Screening occurred annually, and children who screened positive for possible hearing loss or ear disease were monitored for 9 months from the screening date for follow-up. Primary outcome was the time to follow-up after a positive hearing screen; analysis was by intention to treat. The trial was registered with ClinicalTrials.gov, NCT03309553.

FINDINGS

We recruited participants between Oct 10, 2017, and March 28, 2019. 15 communities were randomised: eight (750 children) to telemedicine referral and seven (731 children) to primary care referral. 790 (53·3%) of 1481 children screened positive in at least one study year: 391 (52∤1%) in the telemedicine referral communities and 399 (50∤4%) in the primary care referral communities. Of children referred, 268 (68·5%) in the telemedicine referral communities and 128 (32·1%) in primary care referral communities received follow-up within 9 months. Among children who received follow-up, mean time to follow-up was 41·5 days (SD 55·7) in the telemedicine referral communities and 92·0 days (75·8) in the primary care referral communities (adjusted event-time ratio 17·6 [95% CI 6·8-45·3] for all referred children). There were no adverse events.

INTERPRETATION

Telemedicine specialty referral significantly improved the time to follow-up after hearing screening in Alaska. Telemedicine might apply to other preventive school-based services to improve access to specialty care for rural children.

FUNDING

Patient-Centered Outcomes Research Institute.

Quality of life in children with cochlear implants in Kazakhstan

BACKGROUND

Although cochlear implantation (CI) has been performed in Kazakhstan since 2007 little is known about quality of life of patients after CI. The aim of this study was to assess the health-related quality of life (HRQoL) of Kazakhstani children after CI.

METHODS

Altogether, 53 families with a child using a cochlear implant for at least 1 year participated in the study between July 20, 2019 and February 20, 2020 at the Audiological Сenter of Almaty, Kazakhstan. The parents/caregivers completed the "Children with Cochlear Implants: Parental Perspectives (CCIPP)" questionnaire.

RESULTS

'Well-being and happiness' subdomain of the HRQoL yielded the highest ratings. 'Communication', 'general functioning', 'self-reliance', and 'supporting the child' subdomains each achieved significant (p < 0.01) associations with all HRQoL subdomains. There were positive correlations between language used by the parent who completed the questionnaire (Kazakh or Russian) and three HRQoL subdomains, including 'well-being and happiness', 'supporting the child' and 'social relations'.

CONCLUSION

Parents/caregivers reported high quality of life in all HRQoL subdomains. Further research in this area with more detailed socio-demographic and medical history data is required to identify quality of life predictors in children after cochlear implantation.

Functional Reorganization of the Central Auditory System in Children with Single-Sided Deafness: A Protocol Using fNIRS

In children, single-sided deafness (SSD) affects the development of linguistic and social skills and can impede educational progress. These difficulties may relate to cortical changes that occur following SSD, such as reduced inter-hemispheric functional asymmetry and maladaptive brain plasticity. To investigate these neuronal changes and their evolution in children, a non-invasive technique is required that is little affected by motion artifacts. Here, we present a research protocol that uses functional near-infrared spectroscopy (fNIRS) to evaluate the reorganization of cortical auditory asymmetry in children with SSD; it also examines how the cortical changes relate to auditory and language skills. The protocol is designed for children whose SSD has not been treated, because hearing restoration can alter both brain reorganization and behavioral performance. We propose a single-center, cross-sectional study that includes 30 children with SSD (congenital or acquired moderate-to-profound deafness) and 30 children with normal hearing (NH), all aged 5–16 years. The children undergo fNIRS during monaural and binaural stimulation, and the pattern of cortical activity is analyzed using measures of the peak amplitude and area under the curve for both oxy- and deoxyhemoglobin. These cortical measures can be compared between the two groups of children, and analyses can be run to determine whether they relate to binaural hearing (speech-in-noise and sound localization), speech perception and production, and quality of life (QoL). The results could be of relevance for developing individualized rehabilitation programs for SSD, which could reduce patients’ difficulties and prevent long-term neurofunctional and clinical consequences.

American Cochlear Implant Alliance Task Force Guidelines for Determining Cochlear Implant Candidacy in Children

This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Discriminant Validity of the Parent-Proxy Preschool HEAR-QL

OBJECTIVE

The parent-proxy Preschool HEAR-QL (Hearing Environments And Reflections on Quality of Life) is a quality of life (QOL) measure for 2 to 6-year-old children with hearing loss (HL). We compared Preschool HEAR-QL scores for children with HL and children with normal hearing (NH) to examine the measure's discriminant validity.

STUDY DESIGN

Cross-sectional study.

SETTING

Three tertiary care pediatric otolaryngology clinics.

PATIENTS

Two hundred forty-eight parents of children 2 to 6 years old with NH or HL participated.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

The Preschool HEAR-QL has five domains: Behavior and Attention, Hearing Environments, New Social Situations, Social Interactions, and Communications. Scores range from 0 to 100; higher scores indicate higher QOL. Scores for children with NH and with HL were compared using analysis of variance (ANOVA) and area under the receiver operating characteristic (AUROC) curves.

RESULTS

Total HEAR-QL mean (SD) scores were higher for children with NH compared to children with HL (75.7 [10.5] vs. 67.5 [15.5], p < 0.001). Scores were not significantly different between children with unilateral and bilateral HL. Children 2 to 4 years old received lower Communications-domain scores than children 4 to 6 years old across all children (63.7 [25.4] vs. 74.1 [24.3], p = 0.01) and within the HL cohort (61.3 [25.1] vs. 72.6 [25.3]; p = 0.009). The Hearing Environments domain displayed excellent discrimination (AUROC = 0.858); other domains showed little to no discrimination.

CONCLUSIONS

The Hearing Environments-domain of the Preschool HEAR-QL differentiated between children with and without HL. Children with NH had higher scores than children with HL on both Total HEAR-QL and Hearing Environment-domain scores.

Italian Version of the YQOL-DHH Questionnaire: Translation and Cross-cultural Adaptation

Objective

To translate and cross-culturally adapt into Italian the YQOL-DHH (Youth Quality of Life Instrument–Deaf and Hard of Hearing Module), an instrument to evaluate the health-related quality of life in young deaf people. It could be useful for professionals, teachers, and parents to take care of deaf adolescents’ needs.

Study Design

Forward-backward translation, cross-cultural adaptation, and cognitive debriefing.

Setting

The cognitive debriefing was performed online with professionals and during clinical practice with deaf adolescents.

Methods

A methodological study was conducted according to the guidelines provided by the development team. The study consisted of a forward-backward translation and a cross-cultural adaptation. After the original authors’ confirmation, a cognitive debriefing was conducted with 30 professionals who work with deaf young people and with 10 deaf adolescents aged 11 to 18 years.

Results

For the linguistic translation and cross-cultural adaptation, some variations to the original instrument were made to obtain equivalence, such as the expression “deaf or hard of hearing” translated only with the Italian word “sordo.” During the cognitive debriefing, the clarity and comprehensibility of the items were reported by professionals and deaf adolescents. Eventually, the authors approved the final version.

Conclusion

The YQOL-DHH was translated and culturally adapted into Italian. The translated items were pertinent to the Italian culture and equivalent to the original ones. A validation study is suggested to make the instrument feasible for use in different clinical or educational contexts. In addition, to guarantee accessibility and autonomy for young deaf signers, Italian Sign Language translation of the questionnaire is suggested.

Predicting Quality of Life and Behavior and Emotion from Functional Auditory and Pragmatic Language Abilities in 9-Year-Old Deaf and Hard-of-Hearing Children

Children who are deaf or hard of hearing (DHH) are likely to exhibit difficulties in development of psychosocial skills, pragmatic language skills, and use of hearing for social communication in real-world environments. Some evidence suggests that pragmatic language use affects peer-relationships and school engagement in these children. However, no studies have investigated the influence of functional auditory performance and use of language and speech in real-world environments on children's behavior and emotion, and on their health-related quality of life. This study explored the relationship in DHH children at 9 years of age. Data from 144 participants of the Longitudinal Outcomes of Children with Hearing Impairment study were analyzed. Parent reports were obtained on quality of life, behavior and emotion, pragmatic language skills, and auditory functional performance of children in real life. Children's spoken language abilities and speech intelligibility were assessed by research speech pathologists. On average, performance of children in all domains was within the range of typically developing peers. There were significant associations among functional auditory performance, use of speech and language skills, psychosocial skills, and quality of life. Multiple linear regression analyses revealed that better auditory functional performance and pragmatic language skills, rather than structural language abilities, were associated with better psychosocial abilities and quality of life. The novel findings highlight the importance of targeted intervention for improving functional hearing skills and social communication abilities in DHH children, and emphasize the importance of collaborative approaches among medical, audiology, allied health, and educational professionals to identify those at risk so that timely referral and intervention can be implemented for improving psychosocial health and well-being in DHH children.

Newborn Hearing Screening and Intervention in Children with Unilateral Hearing Impairment: Clinical Practices in Three Nordic Countries

Studies have limitedly considered children with early-identified unilateral hearing impairment (UHI), and clinical practices regarding screening, diagnostics and habilitation in this group are rarely documented. In this study, routines for newborns with UHI from screening to diagnostics and habilitation were explored in Norway, Sweden and Finland. An online survey was sent to hospitals responsible for the hearing diagnostics of children requesting information about their practices regarding congenital UHI. Responses covered 95% of the children born in the three included countries. The results revealed large variations in ways of organising healthcare and in clinical decisions regarding hearing screening, diagnostics and habilitation of children with congenital UHI. Finally, implications for policy making and research are also discussed.

Participation restriction of adults and elderly users of an audiology clinic: association with auditory and social-environmental factors

PURPOSE

To verify the association between restrictions to auditory participation and quality of life, self-perceived health, auditory factors and sociodemographic aspects of adults and elderlies assisted in an audiology service.

METHODS

The study included 152 participants; restrictions to auditory participation were assessed using the instruments Hearing Handicap Inventory for Adults - HHIA and the Hearing Handicap Inventory for Elderly - HHIE. In order to assess the quality of life, participants answered the World Health Organization Quality of Life - abbreviated version (WHOQOL-bref). Sociodemographic characteristics were assessed using a questionnaire to characterize the participants; and by the Brazilian Criteria ABEP. The results of the hearing assessment were also collected. Descriptive, bivariate statistical analyzes (p ≤ 0.20) and multiple logistic regression (p ≤ 0.05) were performed.

RESULTS

Regarding social class, individuals belonging to classes B1 and C2 had, respectively, 4.75 and 7.73 times greater chances of presenting restrictions to auditory participation compared to individuals of class D. Regarding hearing factors, disabling hearing loss increased by 3.4 times the chance of presenting perception of restriction to auditory participation. In the environmental domain of the WHOQOL-bref instrument, each unit increased in the score was associated with a decrease of 0.96 times in the chance of perceived restriction in auditory participation.

CONCLUSION

We found that the use of the amplifying hearing aid by itself, despite its benefits, did not eliminate the restrictions on auditory participation of most participants.

Hearing Aid Use in Children With Unilateral Hearing Loss: A Randomized Crossover Clinical Trial

OBJECTIVES/HYPOTHESIS

In children with mild to moderately severe unilateral hearing loss (UHL), assess whether subject-reported quality of life (QOL) and teacher- and parent-reported perception of listening difficulty are affected by use of a hearing aid (HA) with baseline accommodations, compared to children receiving only baseline accommodations.

STUDY DESIGN

Randomized crossover clinical trial.

METHODS

Thirty-seven children 6-12 years of age with mild to moderately severe UHL and ≥80% word recognition scores in the poorer hearing ear were randomized into arm 1, using baseline accommodations (frequency-modulated system and strategic seating) for 12 weeks, followed by addition of a HA for 12 weeks. The other participants were randomized into the reverse methodology: arm 2, using a HA in addition to baseline accommodations for 12 weeks, followed by baseline accommodations alone. Surveys of QOL (Hearing Environments and Reflection on Quality of Life) and listening difficulties or challenges with hearing amplification (CHILD and LIFE-R questionnaires) were administered at 6-week intervals. Differences in mean survey scores, percent change, and improvement over time were computed between the two arms and inter-arm intervals. Per-protocol analysis was used.

RESULTS

Of the 37 children enrolled, 34 children underwent the study interventions and were included in the analysis, (arm 1 = 20, arm 2 = 14) (mean [standard deviation] age = 8 [1.5] years; 21 boys [61.8%]). Survey scores averaged across both arms during the HA interval (77.79 [15.13]) were significantly higher than during the baseline-only interval (69.67 [14.69], P = .036). There was no significant difference between trial arms in mean scores between the two HA intervals (P = .450) and two baseline-only intervals (P = .539).

CONCLUSIONS

Hearing-related QOL and listening ability improved in children who met eligibility criteria with mild to moderately severe UHL with HA use compared with baseline accommodations alone.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02269124.

LEVEL OF EVIDENCE

1 Laryngoscope, 2021.

Patient Report of Hearing in Neurofibromatosis Type 2: Recommendations for Clinical Trials

OBJECTIVE

To systematically evaluate published patient-reported outcome measures for the assessment of hearing function and hearing-related quality of life (QoL) and recommend measures selected by the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration (REiNS) as endpoints for clinical trials in neurofibromatosis type 2 (NF2).

METHODS

The REiNS Patient-Reported Outcomes Working Group systematically evaluated published patient-reported outcome measures of (1) hearing function and (2) hearing-related QoL for individuals with hearing loss of various etiologies using previously published REiNS rating procedures. Ten measures of hearing functioning and 11 measures of hearing-related QoL were reviewed. Measures were numerically scored and compared primarily on their participant characteristics (including participant age range and availability of normative data), item content, psychometric properties, and feasibility for use in clinical trials.

RESULTS

The Self-Assessment of Communication and the Self-Assessment of Communication-Adolescent were identified as most useful for adult and pediatric populations with NF2, respectively, for the measurement of both hearing function and hearing-related QoL. Measures were selected for their strengths in participant characteristics, item content, psychometric properties, and feasibility for use in clinical trials.

CONCLUSIONS

REiNS recommends the Self-Assessment of Communication adult and adolescent forms for the assessment of patient-reported hearing function and hearing-related QoL for NF2 clinical trials. Further work is needed to demonstrate the utility of these measures in evaluating pharmacologic or behavioral interventions.

Recommendations for Age-Appropriate Testing, Timing, and Frequency of Audiologic Monitoring During Childhood Cancer Treatment: An International Society of Paediatric Oncology Supportive Care Consensus Report

Importance

Ototoxicity is an irreversible direct and late effect of certain childhood cancer treatments. Audiologic surveillance during therapy as part of the supportive care pathway enables early detection of hearing loss, decision-making about ongoing cancer treatment, and, when applicable, the timely use of audiologic interventions. Pediatric oncologic clinical practice and treatment trials have tended to be driven by tumor type and tumor-specific working groups. Internationally accepted standardized recommendations for monitoring hearing during treatment have not previously been agreed on.

Objective

To provide standard recommendations on hearing loss monitoring during childhood cancer therapy for clinical practice.

Methods

An Ototoxicity Task Force was formed under the umbrella of the International Society of Paediatric Oncology, consisting of international audiologists, otolaryngologists, and leaders in the field of relevant pediatric oncology tumor groups. Consensus meetings conducted by experts were organized, aimed at providing standardized recommendations on age-directed testing, timing, and frequency of monitoring during cancer treatment based on literature and consensus. Consensus statements were prepared by the core group, adapted following several videoconferences, and finally agreed on by the expert panel.

Findings

The consensus reached was that children who receive ototoxic cancer treatment (platinum agents, cranial irradiation, and/or brain surgery) require a baseline case history, monitoring of their middle ear and inner ear function, and assessment of tinnitus at each audiologic follow-up. As a minimum, age-appropriate testing should be performed before and at the end of treatment. Ideally, audiometry with counseling before each cisplatin cycle should be considered in the context of the individual patient, specific disease, feasibility, and available resources.

Conclusions and Relevance

This is an international multidisciplinary consensus report providing standardized supportive care recommendations on hearing monitoring in children undergoing potentially ototoxic cancer treatment. The recommendations are intended to improve the care of children with cancer and facilitate comparative research on the timing and development of hearing loss caused by different cancer treatment regimens.

Quality of Life-CI: Development of an Early Childhood Parent-Proxy and Adolescent Version

OBJECTIVES

Severe to profound hearing loss is associated with communication, social, and behavioral difficulties that have been linked to worse health-related quality of life (HRQoL) compared to individuals with normal hearing. HRQoL has been identified as an important health outcome that measures functional ability, particularly for chronic conditions and disabilities. The current study developed the QoL-cochlear implant (CI) for early childhood and adolescents using the recommended Food and Drug Administration and European Medicines Agency guidelines on patient-reported outcomes.

DESIGN

Three phases of instrument development were conducted for both the early childhood (0 to 5 years old; parent proxy) and adolescent/young adult (13 to 22 years old) versions of the QoL-CI. Phase 1 included the development of our conceptual framework, which informed the discussion guides for stakeholder focus groups (e.g., audiologists, physicians, and therapists) at CI clinics in Miami and Philadelphia (n = 39). Open-ended interviews with parents (N = 18 for early childhood; N = 6 for adolescent/young adult version) and adolescents/young adults using CIs (n = 17) were then completed at both sites during phase 2. All interviews were transcribed and coded to identify common themes, which were then used to draft items for the QoL-CI. Both versions of the QoL-CI were developed using Qualtrics to allow for quick, easy electronic administration of the instruments on a tablet device. Last, phase 3 included cognitive testing in a new sample (N = 19 early childhood, N = 19 adolescent) to ensure that the draft instruments were clear, comprehensive, and easy to use.

RESULTS

Participant responses obtained via the open-ended interviews yielded an early childhood and adolescent version of the QoL-CI that was reportedly easy to complete and comprehensive. The final QoL-CI Early Childhood instrument yielded 35 questions across eight functional domains (environmental sounds, communication, social functioning, behavior, CI device management and routines, school, CI benefits, and early intervention). Similarly, the final QoL-CI adolescent/young adult version consisted of 46 items across eight domains (noisy environments, communication, CI usage and management, advocacy, social functioning, emotional functioning, acceptance, and independence).

CONCLUSIONS

The QoL-CI is a condition-specific QoL instrument that can be used for children ages birth through 22 years. These instruments capture the "whole" child by not only focusing on communication and auditory skills but also academic, social and emotional functioning. Once validated, these CI-specific measures will enable providers to track long-term outcomes and evaluate the efficacy of new interventions to improve overall CI use and QoL for pediatric and young adult users.

Parent-Child Agreement on Quality of Life in Children With Hearing Loss Using the HEAR-QL

OBJECTIVE

We explored whether children with hearing loss (HL) and their parents perceive the child's quality of life (QOL) similarly using the Hearing Environment And Reflections on Quality of Life (HEAR-QL) survey.

STUDY DESIGN

Cross-sectional study.

SETTING

Pediatric otolaryngology clinic.

PATIENTS

7 to 14 year old children with unilateral or bilateral HL and their parents.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

The HEAR-QL is a validated hearing-related QOL survey and has three domains and total score, ranging from 0 to 100; higher scores indicate higher QOL.

RESULTS

HEAR-QL total score (r = 0.520, p = 0.011), Activities (r = 0.608, p = 0.002), and Feelings (r = 0.657, p = 0.001) domains correlated strongly, but the hearing Environments domain (r = 0.291, p = 0.178) correlated weakly. Children with mild HL scored total and Environments domains lower than their parents (mean difference [MD] -13.9 [95% CI -34.3, 6.6] and -19.2 [95% CI -41.2, 2.7]; Hedge's g 0.67, 0.77, respectively) compared to children with moderate-to-severe HL (moderate HL MD 8.3 [95% CI -15.7, 32.4] and 13.1 [95% CI -25.2, 51.5]; severe HL MD 9.5 [95% CI 0.6, 18.4] and 14.4 [95% CI 4.3, 24.6]).

DISCUSSION

Children and their parents correlated strongly on observable Feelings And Activities domains scores but correlated weakly on hearing difficulty in Environments scores. Parents of children with mild HL perceived their children's QOL to be better than the children themselves, differing from the moderate-to-severe HL groups.