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Original Investigation
May 14, 2020

Health-Related Quality of Life Changes Associated With Hearing Loss

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
  • 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 3Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
  • 4Department of Economics, McMaster University, Hamilton, Ontario, Canada
  • 5Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
  • 6Health Utilities Incorporated, Hamilton, Ontario, Canada
  • 7Department of Otolaryngology–Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
  • 8Department of Otolaryngology–Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 9University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA Otolaryngol Head Neck Surg. Published online May 14, 2020. doi:10.1001/jamaoto.2020.0674
Key Points

Question  What changes in health-related quality of life are associated with hearing loss?

Findings  In this qualitative study, a systematic literature review of 45 studies including 1036 patients with hearing loss, an expert focus group of 4 audiologists and 4 otologists, and semistructured interviews with 26 individuals with hearing loss were used to identify a comprehensive list of the 29 subdomains of quality of life associated with hearing loss.

Meaning  Understanding the multifaceted associations of hearing loss with health-related quality of life is essential to studying hearing loss conditions and treatments; the framework presented here is useful for generation or evaluation of hearing-related quality of life measures.


Importance  Utility is a single-value, preference-based measure of health-related quality of life that represents the desirability of a health state relative to being dead or in perfect health. Clinical, funding, and policy decisions rely on measured changes in utility. The benefit of hearing loss treatments may be underestimated because existing utility measures fail to capture important changes in quality of life associated with hearing loss.

Objective  To develop a comprehensive profile of items that describe how quality of life is associated with hearing loss and its treatments that can be used to generate hearing-related quality of life measures, including a novel utility measure.

Design, Setting, and Participants  This qualitative study, performed from August 1, 2018, to August 1, 2019, in tertiary referral centers, comprised a systematic literature review, focus groups, and semistructured interviews. The systematic review evaluated studies published from 1982 to August 1, 2018. Focus groups included 8 clinical experts experienced in the measurement, diagnosis, treatment, and rehabilitation of hearing loss. Semistructured interviews included 26 adults with hearing loss recruited from an institutional data set and outpatient hearing aid and otology clinics using stratified convenience sampling to include individuals of diverse ages, urban and rural residency, causes of hearing loss, severity of hearing loss, and treatment experience.

Main Outcomes and Measures  A set of items and subdomains that collectively describe the association of hearing loss with health-related quality of life.

Results  The literature search yielded 2779 articles from the MEDLINE, Embase, Cochrane, PsycINFO, and CINAHL databases. Forty-five studies including 1036 individuals (age range, 18-84 years) were included. The focus group included 4 audiologists and 4 otologists. Hour-long semistructured interviews were conducted with 26 individuals (13 women; median age, 54 years; range, 25-83 years) with a broad range of hearing loss causes, configurations, and severities. From all 3 sources, a total of 125 items were generated and organized into 29 subdomains derived from the World Health Organization’s International Classification of Functioning, Disability and Health.

Conclusions and Relevance  The association of hearing loss with quality of life is multidimensional and includes subdomains that are not considered in the estimation of health utility by existing utility measures. The presented comprehensive profile of items can be used to generate or evaluate measures of hearing-related quality of life, including utility measures.

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