Health-related quality of life in children and adolescents who use cochlear implants

Objective: Examination of health-related quality of life (HRQoL) in children and adolescents who wear a cochlear implant (CI) primarily has depended on parent proxy report of the child's HRQoL rather than child self-report and generic domains rather than CI-specific issues. This study simultaneously assessed self-report ratings on a generic HRQoL instrument and a preliminary CI module in pediatric CI users. The impact of demographic factors (chronologic age, age at CI, and CI experience) on HRQoL also was explored. Methods: This cross-sectional study included 138 children grouped by chronologic age: 4-7, 8-11 and 12-16 years. The KINDL^R questionnaire for measuring HRQoL in children and adolescents (generic) and a preliminary CI module (specific) were completed as a researcher-administered interview (4-7 years) or self-administered questionnaire (8-16 years) at CI summer camp or home. Scores were transformed to a 100-point scale with 100 representing the most positive response. The impact of chronologic age group on HRQoL ratings was evaluated using Analysis of Variance. Spearman rank-order correlations and point-biserial correlations tested associations between demographic factors and HRQoL scores. Principal factor analysis was used to discover the factor structure and internal consistency of the preliminary CI module. Results: The youngest group (M=82.8) rated generic HRQoL significantly more positively than older children (8-11 years: M=75.3; 12-16 years: M=70.4). Similar significant results emerged on the overall CI module (4-7 years: M=79.8; 8-11 years: M=77.8; 12-16 years: M=71.3). The youngest group rated CI-specific items on friends and self-image more positively than older groups, but reported greater difficulties hearing teachers at school. The oldest group provided more consistent responses than younger groups on the CI module (Cronbach α=0.72). Generic and CI module scores correlated positively (r=0.19, p=03) but this association reflects the strong correlation in the oldest group (r=0.49, p=0.0033) and camouflages non-significant results in younger groups. Conclusion: Chronologic age impacts self-report of HRQoL for pediatric CI users such that younger children rate HRQoL more positively than older children and adolescents on a generic instrument and preliminary CI module. Older children provide more consistent responses on the CI module. Results support the need for further development of a CI-specific self-report HRQoL instrument.