Background: Few quality of life (QOL) assessment tools are available for children with specific
chronic conditions, and none have been designed specifically for children with hearing
loss (HL). A validated hearing-related QOL questionnaire could help clinicians determine
whether an intervention is beneficial and whether one intervention is better than
another.
Purpose: To examine QOL in children with HL and assess the validity, reliability, and factor
structure of a new measure, the Hearing Environments and Reflection on Quality of
Life (HEAR-QL) questionnaire.
Research Design: A descriptive and correlational study of a convenience sample of children.
Study Sample: Participants included 35 children with unilateral HL, 45 with bilateral HL, and 35
siblings with normal hearing.
Data Collection and Analysis: Children 7–12 yr old were recruited by mail from a tertiary-care pediatric otolaryngology
practice and the local county's Special School District. With parent consent, children
completed the validated Pediatric Quality of Life Inventory™ (PedsQL) 4.0 and a 35-item HEAR-QL questionnaire. The factor structure of the HEAR-QL
was determined through principal components analysis (PCA), and mean scores were computed
for each subscale and the total HEAR-QL. Three weeks following the return of the initial
questionnaires, a second HEAR-QL questionnaire was sent to participants to assess
test–retest reliability. Both PedsQL and HEAR-QL scores were compared between children
with and without HL, between children with unilateral and bilateral HL, and between
children who used and did not use a hearing device using analysis of variance. Sensitivity
and specificity were calculated for both the HEAR-QL and the PedsQL. A multivariable,
hierarchical linear regression analysis was conducted with independent variables associated
with the HEAR-QL in unadjusted tests.
Results: Using exploratory PCA, the 35-item HEAR-QL was reduced to 26 items (Cronbach's α
= 0.97, sensitivity of 91% and specificity of 92% at a cutoff score of 93.5) loading
on three factors: difficulty hearing in certain environments/situations (Environments
α = 0.97), impact of HL on social/sports activities (Activities α = 0.92), and impact
of HL on child's feelings (Feelings α = 0.88). Sensitivity of 78.8% and specificity
of 30.9% at a cutoff score of 69.6 on the PedsQL (at risk for impaired QOL) were lower
than for the HEAR-QL. Participants with HL reported significantly lower mean total
HEAR-QL scores (71 [SD 18] vs. 98 [SD 5], p < .001), but not mean total PedsQL scores (77 [SD 14] vs. 83 [SD 15], p = .47), than participants with normal hearing. Among children with bilateral HL,
children who used a hearing device reported lower mean total HEAR-QL scores (p = .01), but not mean total PedsQL scores (p = .55), than children who did not use a hearing device. The intraclass correlation
coefficient for test–retest reliability for the 26-item HEAR-QL total score was 0.83.
Hearing status and use of a device were independently associated with the HEAR-QL,
and the variables in the model accounted for 46% of the HEAR-QL total score variance.
Conclusions: The HEAR-QL appears to be a valid, reliable, and sensitive questionnaire for children
with HL. The HEAR-QL was better able than the PedsQL to distinguish between children
with and without HL and can help evaluate interventions for children with HL.
Key Words
children - hearing loss - quality of life - questionnaire
