Supplementary Material for: Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults

Cochlear implants (CI) have increasingly been adopted in older adults with severe to profound sensorineural hearing loss as a result of the growing and aging world population. Consequently, researchers have recently shown great interest in the cost-effectiveness of cochlear implantation and its effect on quality of life (QoL) in older CI users. Therefore, a systematic review and critical evaluation of the available literature on QoL in older adult CI users was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching MEDLINE (PubMed) and the Cochrane Library and by checking the reference lists of relevant articles. Inclusion criteria were as follows: (1) the study sample were adults aged 50 years and older with postlingual onset of bilateral severe to profound hearing loss, (2) all subjects received a multi-electrode CI, and (3) QoL was assessed before and after implantation. Out of 1,093 records, 18 articles were accepted for review. Several studies demonstrated significant positive effects of cochlear implantation on QoL in older adults, but high-level evidence-based medicine is lacking. An improvement of QoL was generally reported when using disease-specific instruments, which are designed to detect treatment-specific changes, whereas the outcomes of generic QoL questionnaires, assessing general health states, were rather ambiguous. However, only generic questionnaires would be able to provide calculations of the cost-effectiveness of CI and comparisons across patient populations, diseases, or interventions. Hence, generic and disease-specific QoL instruments are complementary rather than contradictory. In general, older CI users’ QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. There is a need for a standardized, multidimensional, and comprehensive QoL study protocol including all relevant generic and disease-specific instruments to measure and compare QoL, utility, and/or daily life performance in CI users.

随着全球人口增长与老龄化加剧，重度至极重度感音神经性听力损失的老年群体中，人工耳蜗（Cochlear Implants，CI）的植入应用日益普及。为此，学界近期对老年人工耳蜗使用者的人工耳蜗植入成本效益及其对生活质量（Quality of Life，QoL）的影响产生了浓厚研究兴趣。因此，本研究依据《系统评价与Meta分析首选报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，针对老年人工耳蜗使用者生活质量的现有文献开展了系统综述与批判性评估。研究通过检索MEDLINE（PubMed）与Cochrane图书馆，并筛查相关文献的参考文献列表来筛选纳入研究。纳入标准如下：（1）研究样本为年龄50岁及以上、语后起病的双侧重度至极重度听力损失成年人；（2）所有受试者均接受多电极人工耳蜗植入；（3）在植入前后均对生活质量进行了评估。在1093条检索记录中，最终纳入18篇文献进行综述。多项研究表明，人工耳蜗植入可对老年群体的生活质量产生显著积极影响，但目前尚缺乏高质量循证医学证据。采用专为检测治疗特异性变化而设计的疾病特异性量表进行评估时，通常可报告生活质量得到改善；而用于评估一般健康状态的普适性生活质量问卷所得结果则相当模糊。然而，唯有普适性问卷方可用于计算人工耳蜗植入的成本效益，并开展不同患者群体、疾病或干预措施间的对比。由此可见，普适性与疾病特异性生活质量评估工具并非互斥，而是互为补充。总体而言，现有研究针对老年人工耳蜗使用者的生活质量采用了多样化的评估方法与工具，这加大了不同研究间的对比难度。亟需建立一套标准化、多维度且全面的生活质量研究方案，纳入所有相关普适性与疾病特异性评估工具，以测量并对比人工耳蜗使用者的生活质量、健康效用及/或日常生活表现。