QOL Factors Impact Patient Decision to Undergo Cochlear Implantation

by Linda Kossoff •

CLINICAL QUESTION

What are the barriers and the facilitating factors at play for cochlear implant (CI) candidates who undergo implantation and those who forgo it?

BOTTOM LINE

Although functional outcome expectations are similar between candidates who elect to receive or forgo CI, the latter have higher baseline CI-specific quality of life (QOL) abilities.

BACKGROUND: Despite the benefits that CIs provide for individuals with sensorineural hearing loss who receive limited benefit from hearing amplification, only 6%–10% of potential CI candidates are ever evaluated for a CI implantation. A better understanding of the patient-specific factors underlying the decision to forgo CI is essential in order to meet the needs of the hearing impaired who may benefit from this technology.

STUDY DESIGN: Comparative cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston.

SYNOPSIS: Researchers recruited 43 adult patients undergoing CI evaluations for bilateral sensorineural hearing loss at a single institution. Participants were divided into those electing to proceed with CI surgery (28 patients) and those electing to forgo surgery (15 patients). Participants completed the CI Quality of Life (CIQOL)-35 Profile and CIQOL-Expectations instrument and were surveyed on factors underlying their decision. Testing showed that pure-tone averages were better and sentence recognition scores higher in the no-CI group. CIQOL Expectation scores were comparable, but CIQOL-35 scores suggested differences in baseline functional ability, with emotional and entertainment domains higher in the no-CI group. The most reported barriers to surgery in the no-CI group were fears about complications, implant cost, and perceived degree of personal hearing handicap. The CI group cited a desire to improve communication, belief that a CI would improve hearing quality and ability to interact, and trust in the CI team to deliver positive results. Study limitations included small sample size.

CITATION: Sturm JJ, Brandner G, Ma C, et al. Why do candidates forgo cochlear implantation? Laryngoscope. 2023;133:3548–3553.