Meta-analysis of Cochlear Implantation Outcomes Evaluated With General Health-related Patient-reported Outcome Measures.

OBJECTIVE: Determine the change in general health-related quality of life (HRQOL) after cochlear implantation and association with speech recognition. STUDY DESIGN: Meta-analysis. METHODS: Search was performed following the PRISMA statement using PubMed, Medline, Scopus, and CINAHL. Studies on adult cochlear implant (CI) patients measuring HRQOL before and after cochlear implantation were included. Standardized mean difference (SMD) for each measure and pooled effects were determined. A meta-analysis of correlations was also performed between all non-disease-specific patient-reported outcome measures (PROMs) and speech recognition after cochlear implantation. RESULTS: Twenty-two articles met criteria for meta-analysis of HRQOL improvement, but 15 (65%) were excluded due to incomplete statistical reporting. From the seven articles with 274 CI patients that met inclusion criteria, pooled analyses showed a medium positive effect of cochlear implantation on HRQOL (SMD = 0.79). Subset analysis of the HUI-3 measure showed a large effect (SMD = 0.84). Nine articles with 550 CI patients met inclusion criteria for meta-analysis of correlations between non-disease specific PROMs and speech recognition after cochlear implantation. Pooled analysis showed a low correlation between non-disease-specific PROMs and word recognition in quiet (r = 0.35), sentence recognition in quiet (r = 0.40), and sentence recognition in noise (r = 0.32). CONCLUSION: Although regularly used, HRQOL measures are not intended to measure nor do they accurately reflect the complex difficulties facing CI patients. Only a medium positive effect of cochlear implantation on HRQOL was observed along with a low correlation between non-disease-specific PROMs and speech recognition. The use of such instruments in this population may underestimate the benefit of cochlear implantation.

Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities.

OBJECTIVES: Determine the impact of cochlear implantation on quality of life (QOL) and determine the correlation between QOL and speech recognition ability. STUDY DESIGN: Two authors independently searched PubMed, Medline, Scopus, and the Cumulative Index to Nursing and Allied Health Literature to identify studies reporting hearing-specific or cochlear implant (CI)-specific QOL outcomes before and after cochlear implantation, and studies reporting correlations between QOL and speech recognition after cochlear implantation. Data from the included articles were obtained independently by two authors. Standardized mean difference (SMD) for each measure and pooled effects were determined to assess improvement in QOL before and after cochlear implantation. RESULTS: From 14 articles with 679 CI patients who met the inclusion criteria, pooled analyses of all hearing-specific QOL measures revealed a very strong improvement in QOL after cochlear implantation (SMD = 1.77). Subset analysis of CI-specific QOL measures also showed very strong improvement (SMD = 1.69). Thirteen articles with 715 patients met the criteria to evaluate associations between QOL and speech recognition. Pooled analyses showed a low positive correlation between hearing-specific QOL and word recognition in quiet (r = 0.213), sentence recognition in quiet (r = 0.241), and sentence recognition in noise (r = 0.238). Subset analysis of CI-specific QOL showed similarly low positive correlations with word recognition in quiet (r = 0.213), word recognition in noise (r = 0.241), and sentence recognition in noise (r = 0.255). CONCLUSIONS: Using hearing-specific and CI-specific measures of QOL, patients report significantly improved QOL after cochlear implantation. However, widely used clinical measures of speech recognition are poor predictors of patient-reported QOL with CIs. Laryngoscope, 128:982-990, 2018.

Recent randomized controlled trials in otolaryngology.

OBJECTIVE: To assess recent trends in the prevalence and quality of reporting of randomized controlled trials (RCTs) in 4 otolaryngology journals. STUDY DESIGN: Methodology and reporting analysis. SETTING: Randomized controlled trials in 4 otolaryngology journals. SUBJECTS AND METHODS: All RCTs published from 2011 to 2013 in 4 major otolaryngology journals were examined for characteristics of study design, quality of design and reporting, and funding. RESULTS: Of 5279 articles published in 4 leading otolaryngology journals from 2011 to 2013, 189 (3.3%) were RCTs. The majority of RCTs were clinical studies (86%), with the largest proportion consisting of sinonasal topics (31%). Most interventions were medical (46%), followed by surgical (38%) and mixed (16%). In terms of quality, randomization method was reported in 54% of RCTs, blinding in 33%, and adverse events in 65%. Intention-to-treat analysis was used in 32%; P values were reported in 87% and confidence intervals in 10%. Research funding was most often absent or not reported (55%), followed by not-for-profit (25%). CONCLUSIONS: Based on review of 4 otolaryngology journals, RCTs are still a small proportion of all published studies in the field of otolaryngology. There seem to be trends toward improvement in quality of design and reporting of RCTs, although many quality features remain suboptimal. Practitioners both designing and interpreting RCTs should critically evaluate RCTs for quality.

Outcomes of cochlear implantation in adults with asymmetric hearing loss.

OBJECTIVE: To analyze speech recognition outcomes in adult cochlear implant recipients who have asymmetric sensorineural hearing loss between the two ears. STUDY DESIGN: Retrospective cohort study of 35 adults with asymmetric hearing loss. Preoperative unaided pure-tone averages (PTA), and pre- and post-op (6 and 12 mo) aided Consonant Nucleus Consonant (CNC) words and sentence recognition scores were obtained for ears in isolation (opposite ear plugged). Patients were categorized according to the PTA of the implanted and contralateral ears as (a) moderate-severe, (b) moderate-profound, and (c) severe-profound. SETTING: A single tertiary care center. PATIENTS: Adults with asymmetric PTA implanted unilaterally at our institution. INTERVENTION: Cochlear implantation with devices approved by the U.S. Food and Drug Administration. MAIN OUTCOME MEASURE(S): Post-implantation word, phoneme, and sentence recognition in the cochlear implant alone testing condition. RESULTS: Patients who were implanted in the worse-hearing ear (n = 21) performed significantly better on CNC words and phonemes at 6 and 12 months than patients who were implanted in the better-hearing ear (n = 14). Patients with the worse ear implanted also obtained 6 to 12% higher sentence recognition scores than the group received an implant in their better ear, although this difference is not statistically significant (p = 0.06 at 6 mo; p = 0.1 at 12 mo). CONCLUSION: Patients with asymmetrical hearing loss who were implanted in the worse-hearing ear achieved 15% greater CNC word scores and 6 to 12% greater sentence scores than patients implanted in the better-hearing ear in the first year after surgery. Our results provide further support for clinicians to use caution if considering implanting the better-hearing ear in patients with asymmetric hearing loss.