CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2020; 24(03): e338-e346
DOI: 10.1055/s-0039-3399540
Original Research
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

The Outcome of Unilateral Cochlear Implantation in Adults: Speech Recognition, Health-Related Quality of Life and Level of Anxiety and Depression: a One- and Three-Year Follow-Up Study

1   Department of Otorhinolaryngology, Jönköping County hospital, Jönköping, Sweden
2   Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
3   Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
Björn Lyxell
4   Department of Special Needs Education, Oslo University, Oslo, Norway
5   Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
Henrik Harder
3   Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
Elina Mäki-Torkko
2   Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
3   Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
5   Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
6   Faculty of Medicine and Health, Örebro University, Örebro, Sweden
› Author Affiliations
Funding The present study was supported by the Swedish Research Council for health, Working Life and Welfare FAS dnr 2010–0761.
Further Information

Publication History

27 March 2019

24 September 2019

Publication Date:
13 December 2019 (online)


Introduction Hearing impairment is a common disease worldwide, with a comprehensive impact, and cochlear implantation (CI) is an intervention for profound hearing impairment.

Objective To study the outcome one and three years after unilateral CI on hearing, health-related quality of life and level of depression and anxiety, and the correlation between the outcomes. Second, to study whether age, gender, etiology, operated side, residual hearing or cognitive performance can predict the outcome.

Methods A prospective longitudinal study including adults with profound postlingual hearing impairment, with respect to hearing (speech recognition), health-related quality of life (Health Utilities Index 3) and level of depression and anxiety (Hospital Anxiety and Depression scale), pre-CI, and one and three years post-CI. The total sample was composed of 40 participants (40% of men), with a mean age of 71 years.

Results Speech recognition and the overall health-related quality of life improved one year post-CI (p = 0.000), without correlation (ρ= 0.27), and with no difference three years post-CI. The hearing attribute (in the health-related quality of life instrument) improved one and three years post-CI (p = 0.000). The level of anxiety did not change one and three years post-CI. The level of depression improved one year post-CI (p = 0.036), and deteriorated three years post-CI (p = 0.031). Age, etiology, operated side, residual hearing and cognitive performance did not predict the outcome, but the female gender did significantly improve speech recognition compared with men (p = 0.009).

Conclusion The CI significantly improved speech recognition, health-related quality of life and level of depression one year post-CI without mutual correlation, and women performed significantly better than men. There were no further improvements three years post-CI, apart from the hearing attribute.

  • References

  • 1 Saunders JE, Rankin Z, Noonan KY. Otolaryngology and the Global Burden of Disease. Otolaryngol Clin North Am 2018; 51 (03) 515-534
  • 2 Sjöstedt C. Annual Report from the ENT-Quality Register in Sweden 2014. SVENSK ÖNH TIDSKRIFT. 2015 (SA1/2015):10.
  • 3 Dalton DS, Cruickshanks KJ, Klein BE, Klein R, Wiley TL, Nondahl DM. The impact of hearing loss on quality of life in older adults. Gerontologist 2003; 43 (05) 661-668
  • 4 Ringdahl A, Grimby A. Severe-profound hearing impairment and health-related quality of life among post-lingual deafened Swedish adults. Scand Audiol 2000; 29 (04) 266-275
  • 5 Li CM, Zhang X, Hoffman HJ, Cotch MF, Themann CL, Wilson MR. Hearing impairment associated with depression in US adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngol Head Neck Surg 2014; 140 (04) 293-302
  • 6 Carlsson PI, Hjaldahl J, Magnuson A. , et al. Severe to profound hearing impairment: quality of life, psychosocial consequences and audiological rehabilitation. Disabil Rehabil 2015; 37 (20) 1849-1856
  • 7 Genther DJ, Betz J, Pratt S. , et al; Health, Aging and Body Composition Study. Association Between Hearing Impairment and Risk of Hospitalization in Older Adults. J Am Geriatr Soc 2015; 63 (06) 1146-1152
  • 8 Feeny D, Huguet N, McFarland BH, Kaplan MS, Orpana H, Eckstrom E. Hearing, mobility, and pain predict mortality: a longitudinal population-based study. J Clin Epidemiol 2012; 65 (07) 764-777
  • 9 Bond M, Mealing S, Anderson R. , et al. The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults: a systematic review and economic model. Health Technol Assess 2009; 13 (44) 1-330
  • 10 healthcare tSnbowa. The Swedish national board of well and healthcare, 2011 2011 [Available from: .
  • 11 Damen GW, Beynon AJ, Krabbe PF, Mulder JJ, Mylanus EA. Cochlear implantation and quality of life in postlingually deaf adults: long-term follow-up. Otolaryngol Head Neck Surg 2007; 136 (04) 597-604
  • 12 Capretta NR, Moberly AC. Does quality of life depend on speech recognition performance for adult cochlear implant users?. Laryngoscope 2016; 126 (03) 699-706
  • 13 Chung J, Chueng K, Shipp D. , et al. Unilateral multi-channel cochlear implantation results in significant improvement in quality of life. Otol Neurotol 2012; 33 (04) 566-571
  • 14 Klop WM, Boermans PP, Ferrier MB, van den Hout WB, Stiggelbout AM, Frijns JH. Clinical relevance of quality of life outcome in cochlear implantation in postlingually deafened adults. Otol Neurotol 2008; 29 (05) 615-621
  • 15 Straatman LV, Huinck WJ, Langereis MC, Snik AF, Mulder JJ. Cochlear implantation in late-implanted prelingually deafened adults: changes in quality of life. Otol Neurotol 2014; 35 (02) 253-259
  • 16 Lassaletta L, Castro A, Bastarrica M, de Sarria MJ, Gavilan J. Quality of life in postlingually deaf patients following cochlear implantation. Eur Arch Otorhinolaryngol 2006; 263 (03) 267-270
  • 17 Hirschfelder A, Gräbel S, Olze H. The impact of cochlear implantation on quality of life: the role of audiologic performance and variables. Otolaryngol Head Neck Surg 2008; 138 (03) 357-362
  • 18 McRackan TR, Bauschard M, Hatch JL. , et al. Meta-analysis of Cochlear Implantation Outcomes Evaluated With General Health-related Patient-reported Outcome Measures. Otol Neurotol. 2018; 39 (01) 29-36
  • 19 Lenarz M, Sönmez H, Joseph G, Büchner A, Lenarz T. Long-term performance of cochlear implants in postlingually deafened adults. Otolaryngol Head Neck Surg 2012; 147 (01) 112-118
  • 20 Ruffin CV, Tyler RS, Witt SA, Dunn CC, Gantz BJ, Rubinstein JT. Long-term performance of Clarion 1.0 cochlear implant users. Laryngoscope 2007; 117 (07) 1183-1190
  • 21 Jolink C, Helleman HW, van Spronsen E, Ebbens FA, Ravesloot MJ, Dreschler WA. The long-term results of speech perception in elderly cochlear implant users. Cochlear Implants Int 2016; 17 (03) 146-150
  • 22 Hilly O, Hwang E, Smith L. , et al. Cochlear implantation in elderly patients: stability of outcome over time. J Laryngol Otol 2016; 130 (08) 706-711
  • 23 Holden LK, Finley CC, Firszt JB. , et al. Factors affecting open-set word recognition in adults with cochlear implants. Ear Hear 2013; 34 (03) 342-360
  • 24 Kraaijenga VJ, Smit AL, Stegeman I, Smilde JJ, van Zanten GA, Grolman W. Factors that influence outcomes in cochlear implantation in adults, based on patient-related characteristics - a retrospective study. Clin Otolaryngol 2016; 41 (05) 585-592
  • 25 Lenarz M, Sönmez H, Joseph G, Büchner A, Lenarz T. Effect of gender on the hearing performance of adult cochlear implant patients. Laryngoscope 2012; 122 (05) 1126-1129
  • 26 Green KM, Bhatt Y, Mawman DJ. , et al. Predictors of audiological outcome following cochlear implantation in adults. Cochlear Implants Int 2007; 8 (01) 1-11
  • 27 Bodmer D, Shipp DB, Ostroff JM. , et al. A comparison of postcochlear implantation speech scores in an adult population. Laryngoscope 2007; 117 (08) 1408-1411
  • 28 Shin MS, Song JJ, Han KH. , et al. The effect of psychosocial factors on outcomes of cochlear implantation. Acta Otolaryngol 2015; 135 (06) 572-577
  • 29 Liden G. Speech audiometry; an experimental and clinical study with Swedish language material. Acta Otolaryngol Suppl 1954; 114: 1-145
  • 30 Descriptions for pure-tone audiograms. British Journal of audiology. 1988 (22:2):123
  • 31 Patrick DLEP. Health Status and Health Policy: Quality of life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press; 1993: 478
  • 32 Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI): concepts, measurement properties and applications. Health Qual Life Outcomes 2003; 1: 54
  • 33 Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52 (02) 69-77
  • 34 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
  • 35 Carlsson PI, Hall M, Lind KJ, Danermark B. Quality of life, psychosocial consequences, and audiological rehabilitation after sudden sensorineural hearing loss. Int J Audiol 2011; 50 (02) 139-144
  • 36 Studebaker GAA. A “rationalized” arcsine transform. J Speech Hear Res 1985; 28 (03) 455-462
  • 37 Yang Y, Longworth L, Brazier J. An assessment of validity and responsiveness of generic measures of health-related quality of life in hearing impairment. Qual Life Res 2013; 22 (10) 2813-2828
  • 38 Grutters JP, Joore MA, van der Horst F, Verschuure H, Dreschler WA, Anteunis LJ. Choosing between measures: comparison of EQ-5D, HUI2 and HUI3 in persons with hearing complaints. Qual Life Res 2007; 16 (08) 1439-1449
  • 39 Ramakers GG, Smulders YE, van Zon A. , et al. Agreement between health utility instruments in cochlear implantation. Clin Otolaryngol 2016; 41 (06) 737-743
  • 40 Drummond M. Introducing economic and quality of life measurements into clinical studies. Ann Med 2001; 33 (05) 344-349
  • 41 Lenarz T, James C, Cuda D. , et al. European multi-centre study of the Nucleus Hybrid L24 cochlear implant. Int J Audiol 2013; 52 (12) 838-848
  • 42 Arnoldner C, Lin VY, Bresler R. , et al. Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3. Laryngoscope 2014; 124 (11) 2586-2590
  • 43 Karinen PJ, Sorri MJ, Välimaa TT, Huttunen KH, Löppönen HJ. Cochlear implant patients and quality of life. Scand Audiol Suppl 2001; 52 (52) 48-50
  • 44 Turunen-Taheri S, Skagerstrand Å, Hellström S, Carlsson PI. Patients with severe-to-profound hearing impairment and simultaneous severe vision impairment: a quality-of-life study. Acta Otolaryngol 2017; 137 (03) 279-285
  • 45 Francis HW, Yeagle JA, Thompson CB. Clinical and psychosocial risk factors of hearing outcome in older adults with cochlear implants. Laryngoscope 2015; 125 (03) 695-702
  • 46 Távora-Vieira D, Marino R, Acharya A, Rajan GP. The impact of cochlear implantation on speech understanding, subjective hearing performance, and tinnitus perception in patients with unilateral severe to profound hearing loss. Otol Neurotol 2015; 36 (03) 430-436