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Cochlear implants (CI) have been increasingly adopted in older adults with severe to profound hearing loss as a result of the growing and ageing world population. There is much interest in the cost-effectiveness and quality of life in CI users. The authors have performed a systematic review and critical evaluation of the literature assessing health-related quality of life (HRQoL) in the over 50s. Their review followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Eligibility criteria of participants states adults aged over 50 years and older with post-lingual onset of bilateral severe to profound hearing loss. They included 18 studies in their qualitative analysis. The majority (15) were prospective longitudinal cohort studies. QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. Studies generally reported a significant improvement of disease-specific HRQoL using disease-specific or CI-specific questionnaires, the Nijmegen Cochlear Implant questionnaire (NCIQ) being the most commonly adopted. The NCIQ is a self-assessment HRQoL instrument with three principal domains: physical, psychological and social. The authors discuss how objective speech recognition measures are only weakly associated with subjective self-reported HRQoL. Generic HRQoL questionnaires were assessed (used across patient populations, disorders and interventions). They found that generic HRQoL questionnaire outcomes were less consistent than hearing-specific questionnaire outcomes; possibly too general to be able to uncover all the improvements a CI can entail. The authors found the methodology of HRQoL analysis to be heterogenous for types of instruments used and the individual patient’s hearing level. They recommend future studies should use a standardised multidimensional, and comprehensive study protocol, including generic and complementary disease-specific HRQoL instruments tailored purposefully to measure HRQoL, utility, and/or daily performance. I found this review well written and informative despite the issues with study heterogeneity. Given the National Institute of Health & Care Excellence (NICE) guidelines update for CI candidacy in 2019, it is useful to highlight the QoL improvements that can be gained in the older population. – AF

Systematic review of quality of life assessments after cochlear implantation in older adults.
Andries E, Gilles A, Topsakal V, et al.
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Aaron SJ Ferguson

Department of Otolaryngology, Ninewells Hospital, UK.

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