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Quality of Life Improvement

Posted By Naama Tsach, PhD, Tuesday, August 16, 2016
Updated: Sunday, August 14, 2016

Quality of Life Improvement Following Cochlear Implantation

Recipients Anticipate that Better Hearing will Improve Quality of Life

The expectation that one’s quality of life will improve with a CI arises from the recognition of the all-encompassing negative effect that a hearing loss has on one's well-being. Adult CI candidates typically anticipate that better hearing following CI will lead to a better quality of life.

Although the research on CI outcomes focuses on auditory skills, there are a growing number of studies that have assessed the way cochlear implantation impacts on quality of life. According to these studies, adult CI users often report positive effects such as easier communication and socialization, greater independence, expanded occupational opportunities, improved sense of well-being, decreased levels of self-perceived hearing handicap, and decreased levels of depression and anxiety. However, outcomes vary and there is no reliable way to predict the impact of CI on different aspects of one's quality of life.

Quality of Life Improvements Vary by Individual

The improvement in quality of life following CI is an individual experience that can be expressed in many different ways. This blog post will focus on individual experiences, rather than quantitative data. I am sure many readers have their own unique insights regarding the contribution that a cochlear implant made to their quality of life. These personal insights are a valuable source of information for CI candidates, CI users, families, and professionals. Different people assess improvement in their quality of life according to different measures and hence weigh the impact in different ways.

A patient of mine was happy with his CI from the very first weeks after following activation. He enjoyed listening and trying to detect environmental sounds that he had never heard before. He experienced the auditory information he was receiving as a new and intriguing gift. He felt he had been blessed with his improved sound awareness even though he never managed to understand sentences without speechreading. Importantly, we had never defined "understanding sentences without speech reading" as a practical goal for him given his hearing history. Another CI user, who was considered a "star patient" based upon her speech perception outcomes, felt frustrated because the CI did not provide her with normal hearing. It took time before she recognized and appreciated the benefits of the CI and its contribution to her quality of life.

Expectations: Everyone is Different

Many CI users deal with "emotional baggage" which includes a sense of hearing impairment, experiences of difficulties in communication and social interactions, and expectations—theirs, family members’ and friends’. These, as well as other factors, affect perception of the CI contribution to a person’s quality of life. A judgmental attitude towards people's perception of their quality of life is useless. There is no objective right and wrong. CI users, families and professionals should respect the variety in outcomes, as well as the possible gaps between the user's feelings and their "actual" auditory achievement. We all need to be patient and supportive.

Quality of Life Benefits Are Not Just About Speech Perception Scores

Although the improvement in quality of life correlates with the improvement in speech perception, it is important to note that it is not restricted to a certain objective level of speech perception skills. Even people with relatively "poor" auditory skills can experience meaningful contributions to their quality of life.

The following examples illustrate two CI users who differ in their auditory functioning. Both are satisfied with the contribution that a CI made to their quality of life.

One person is grateful that the CI allows her to feel safer and more oriented to her surroundings. She wrote:

"I gained the ability to hear a variety of sounds and use them daily. I especially appreciate my ability to understand invisible sounds. The CI made a huge change in my life as I now can rely more on hearing and less on sight and touch. In the past, when I locked the car I've always been trying to open the door in order to check if it is locked. Today I don't need to check anymore. I can be at home on the second floor and figure out that my husband is washing dishes downstairs without seeing him. I can hear my children fighting and go to stop them. Before I had the implant nobody stopped their fighting." 

The other woman, who previously worked as a director of a large company, reported on a huge improvement in her ability to cope with group meetings. She is able to talk on the phone with family and friends, she can follow some TV programs (without captioning), and she enjoys listening to music.

It is clear that these two examples represent women with different auditory abilities, pre and post implantation. Yet, both of them use the CI regularly (even when they are at home alone). They both experienced an improved sense of well-being and significant benefit in daily situations in which they previously struggled before they received a cochlear implant.

Assessing Your Quality of Life Changes

To assess the contribution of the CI to your quality of your life, you might ask yourself some question comparing your pre-implant feelings to your current situation post CI. For example, before receiving a CI:
• What were the reasons you pursued a CI?
• In what ways has your hearing disability limited your daily life?
• Which specific situations were difficult for you to cope with before the implant (i.e., at home, work, or with certain people).
• Did you avoid certain situations and why?
• What strategies did you use in order to cope with these difficulties?
• Did you experience any stress or depression due to your hearing disability?

Now, post cochlear implantation, consider the following:

• Do you enjoy listening with your CI?
• Do you feel there is enhancement in communication (hearing, speaking, and speech-reading)? Can you define these situations?
• Do you feel more comfortable in social and communicational situations that used to be stressful prior the implantation?
• Do you feel more self-confident to do things you did not do in the past?
• Do you feel more independent?
• Do you feel that you have achieved the goals that you set for yourself prior to implantation? Which goals have already been achieved? Which goals have not yet been achieved?
• Are you satisfied with your CI?

Focusing on benefits can be a very empowering, constructive, and supportive method of action that may contribute to your perception of improved quality of life. Some studies note quality of life improvements as early as 9 months post implantation. However, the auditory outcomes continue to improve for the first few years. It is important to view the improvement in quality of life as a long-term process and expect the growth of benefits resulting from your CI to be reflected in various aspects of your life over time.

Further Reading:

Loeffler C et al. 2010. Quality of Life Measurements After Cochlear Implantation. The Open Otorhinolaryngology Journal, 2010, 4, 47-54 47 1874-4281/10. Bentham Open Access

Zaidman-Zait A. 2010. Quality of Life among Cochlear Implant Recipients. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation.

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Mary Beth Napoli says...
Posted Tuesday, August 16, 2016
Good points. It actually took me awhile to stop focusing on the CNC score results with my CIs. I think years and years of watching my speech discrim scores decreasing, which also matched my decreased functioning in real life, left me placing too much emphasis on booth testing scores. Then I started to realize that my actual functioning with my CIs was what was important no matter what the booth testing showed. Focusing on what we can hear with our CIs and what we want to work on hearing better is far more beneficial.
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The mission of the American Cochlear Implant (ACI) Alliance is to advance access to the gift of hearing provided by cochlear implantation through research, advocacy and awareness.