J Am Acad Audiol 2020; 31(04): 292-301
DOI: 10.3766/jaaa.19047
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How Does Quality of Life Relate to Auditory Abilities? A Subitem Analysis of the Nijmegen Cochlear Implant Questionnaire

Kara J. Vasil
1   Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
Jessica Lewis
1   Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
Terrin Tamati
1   Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
Christin Ray
1   Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
Aaron C. Moberly
1   Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH
› Author Affiliations
Funding This work was supported by the American Otological Society Clinician-Scientist Award and the National Institutes of Health, National Institute on Deafness, and Other Communication Disorders (NIDCD) Career Development Award 5K23DC015539-02 to Aaron Moberly. Research reported in this article received IRB approval from the Ohio State University. ACM receives grant funding support from Cochlear Americas for an unrelated investigator-initiated research study.
Further Information

Publication History

Publication Date:
15 April 2020 (online)


Background Objective speech recognition tasks are widely used to measure performance of adult cochlear implant (CI) users; however, the relationship of these measures with patient-reported quality of life (QOL) remains unclear. A comprehensive QOL measure, the Nijmegen Cochlear Implant Questionnaire (NCIQ), has historically shown a weak association with speech recognition performance, but closer examination may indicate stronger relations between QOL and objective auditory performance, particularly when examining a broad range of auditory skills.

Purpose The aim of the present study was to assess the NCIQ for relations to speech and environmental sound recognition measures. Identifying associations with certain QOL domains, subdomains, and subitems would provide evidence that speech and environmental sound recognition measures are relevant to QOL. A lack of relations among QOL and various auditory abilities would suggest potential areas of patient-reported difficulty that could be better measured or targeted.

Research Design A cross-sectional study was performed in adult CI users to examine relations among subjective QOL ratings on NCIQ domains, subdomains, and subitems with auditory outcome measures.

Study Sample Participants were 44 adult experienced CI users. All participants were postlingually deafened and had met candidacy requirements for traditional cochlear implantation.

Data Collection and Analysis Participants completed the NCIQ as well as several speech and environmental sound recognition tasks: monosyllabic word recognition, standard and high-variability sentence recognition, audiovisual sentence recognition, and environmental sound identification. Bivariate correlation analyses were performed to investigate relations among patient-reported NCIQ scores and the functional auditory measures.

Results The total NCIQ score was not strongly correlated with any objective auditory outcome measures. The physical domain and the advanced sound perception subdomain related to several measures, in particular monosyllabic word recognition and AzBio sentence recognition. Fourteen of the 60 subitems on the NCIQ were correlated with at least one auditory measure.

Conclusions Several subitems demonstrated moderate-to-strong correlations with auditory measures, indicating that these auditory measures are relevant to the QOL. A lack of relations with other subitems suggests a need for the development of objective measures that will better capture patients' hearing-related obstacles. Clinicians may use information obtained through the NCIQ to better estimate real-world performance, which may support improved counseling and development of recommendations for CI patients.


Data from this manuscript were presented at the annual conference of the American Academy of Audiology, Columbus, OH, March 27–30, 2019.

  • References

  • 1 Boothroyd A, Hanin L, Hnath T. CUNY Laser Videodisk of Everyday Sentences. New York, NY: Speech and Hearing Sciences Research Center, City University of New York; 1985
  • 2 Capretta NR, Moberly AC. Does quality of life depend on speech recognition performance for adult cochlear implant users?. Laryngoscope 2016; 126: 699-706
  • 3 Dorman MF, Liss J, Wang S, Berisha V, Ludwig C, Natale SC. Experiments on auditory-visual perception of sentences by users of unilateral, bimodal, and bilateral cochlear implants. J Speech Lang Hear Res 2016; 59: 1505-1519
  • 4 FDA-NIH Biomarker Working Group. BEST (Biomarkers, EndpointS, and other Tools) Resource [Internet]. Co-published by Food and Drug Administration, Silver Spring, MD & National Institutes of Health, Bethesda, MD. 2016
  • 5 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
  • 6 Gatehouse S, Noble W. The speech, spatial, and qualities of hearing scale (SSQ). Int J Audiol 2004; 43: 85-99
  • 7 Gaylor JM, Raman G, Chung M, Lee J, Rao M, Lau J, Poe DS. Cochlear implantation in adults: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2013; 139: 265-272
  • 8 Gilbert JL, Tamati TN, Pisoni DB. Development, reliability, and validity of PRESTO: a new high-variability sentence recognition test. J Am Acad Audiol 2013; 24: 26-36
  • 9 Hinderink JB, Krabbe PF, Van Den Broek P. Development and application of a health-related quality-of-life instrument for adults with cochlear implants: the Njimegen Cochlear Implant Questionnaire. J Otolaryngol Head Neck Surg 2000; 123: 756-765
  • 10 Hirsh I, Davis H, Silverman S, Reynolds E, Eldert E, Benson R. Development of materials for speech audiometry. J Speech Hear Disord 1952; 17: 321-337
  • 11 IEEE. IEEE recommended practice for speech quality measurements. IEEE Report, 297. The Institute of Electrical and Electronics Engineers, Inc.; New York: 1969
  • 12 Krabbe PF, Hinderink JB, Van Den Broek P. The effect of cochlear implant use in postlingually deaf adults. Int J Technol Assess Health Care 2000; 16: 864-873
  • 13 Luo X, Kern A, Pulling KR. Vocal emotion recognition performance predicts the quality of life in adult cochlear implant users. J Acoust Soc Am 2018; 144: 429-435
  • 14 McRackan T, Bauschard M, Hatch JL, Franko-Tobin E, Droghini R, Nguyen SA, Dubno JR. Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities. Laryngoscope 2018; 128: 982-990
  • 15 Moberly AC, Harris MS, Boyce L, Vasil K, Wucinich T, Pisoni DB, Baxter J, Ray C, Shafiro V. Relating quality of life to outcomes and predictors in adult cochlear implant users: are we measuring the right things?. Laryngoscope 2018; 128: 959-966
  • 16 Moberly AC, Vasil KJ, Ray C. Visual reliance during speech recognition in cochlear implant users and candidates. J Am Acad Audiol 2019 [Epub ahead of print]
  • 17 Newman CW, Weinstein BE, Jacobson GP, Hug GA. The Hearing Handicap Inventory for Adults: psychometric adequacy and audiometric correlates. Ear Hear 1990; 11: 430-433
  • 18 Olze H, Grabel S, Haupt H, Forster U, Mazurek B. Extra benefit of a second cochlear implant with respect to health-related quality of life and tinnitus. Otol Neurotol 2012; 33: 1169-1175
  • 19 Shafiro V. Development of a large-item environmental sound test and the effects of short-term training with spectrally-degraded stimuli. Ear Hear 2008; 29: 775-790
  • 20 Spahr AJ, Dorman MF, Litvak LM, Van Wie S, Gifford RH, Loizou PC, Loiselle LM, Oakes T, Cook S. Development and validation of the AzBio sentence lists. Ear Hear 2012; 33: 112-117
  • 21 Tye-Murray N, Tyler RS, Woodworth GG, Gantz BJ. Performance over time with a nucleus or ineraid cochlear implant. Ear Hear 1992; 13: 200-209
  • 22 Wilkinson GS, Robertson GJ. 2006. Wide Range Achievement Test-4 (WRAT-4). Lutz, FL: Psychological Assessment Resources, Inc.;