Hearing Handicap Ratings Among Different Profiles of Adult Cochlear Implant Users

In Brief Objective: The aim was to compare outcomes in the domain of self-reported hearing handicap across groups of patients fit with one versus two cochlear implants (CI, CI + CI), or with an implant and a hearing aid (HA) in the nonimplanted ear (CI + HA). Design: The design was retrospective, and a preliminary step was to factor analyze the two measures used, namely, the Hearing Handicap Inventory for the Elderly (HHIE) and the Hearing Handicap Questionnaire (HHQ). Longer versus shorter-term experience with a single implant profile was compared, and further analysis confined to patients fit for less than 100 mo across the three profiles. Pre- versus postimplant self-report and performance (speech test, localization) data were also compared. Results: Three factors were identified in the HHIE, labeled Emotional Distress (HHIE), Difficulty in Hearing, and Social Restriction (HHIE). Highest handicap score for Emotional Distress (HHIE) was observed in the CI + HA group. There were significantly lower scores for Difficulty in Hearing in the CI + CI group than in the CI (p = 0.02) or CI + HA (p = 0.001) groups. On the Social Restriction (HHIE) subscale, the CI + CI group reported significantly lower rating than the CI (p = 0.009) or CI + HA (p = 0.006) groups. Two factors were identified in the HHQ, labeled Emotional Distress (HHQ) and Social Restriction (HHQ). Significantly higher Emotional Distress (HHQ) score was observed in the CI + HA group than in the CI + CI group (p = 0.002); significantly lower Social Restriction (HHQ) score was found in the CI + CI group than in the CI (p = 0.02) or CI + HA (p < 0.001) groups. Pre-post speech test performance showed least contrast in the CI + HA group. Conclusions: Outcomes demonstrate an evident reduction from single or bilateral implantation in the area of emotional distress and a further advantage from bilateral implantation in the areas of hearing difficulty and social restriction. We found that bilateral implants offer significantly greater relief in terms of the experience of Social Restriction compared with a single implant, as measured by the Hearing Handicap Inventory for the Elderly, and that the trend is toward less Emotional Distress in the bilateral group. The HHIE was found to measure a Hearing Difficulty factor that was significantly lower in the bilateral group. People who retained a hearing aid in the non-implanted ear were highest in post-implant Emotional Distress, and showed the least contrast in pre-versus post-implant speech perception ability.