title: Health-related quality of life in children and adolescents who use cochlear implants.
abstract: OBJECTIVE
  Examination of health-related quality of life (HRQoL) in children and adolescents who wear a cochlear implant (CI) primarily has depended on parent proxy report of the child's HRQoL rather than child self-report and generic domains rather than CI-specific issues. This study simultaneously assessed self-report ratings on a generic HRQoL instrument and a preliminary CI module in pediatric CI users. The impact of demographic factors (chronologic age, age at CI, and CI experience) on HRQoL also was explored.
  
  
  METHODS
  This cross-sectional study included 138 children grouped by chronologic age: 4-7, 8-11 and 12-16 years. The KINDL(R) questionnaire for measuring HRQoL in children and adolescents (generic) and a preliminary CI module (specific) were completed as a researcher-administered interview (4-7 years) or self-administered questionnaire (8-16 years) at CI summer camp or home. Scores were transformed to a 100-point scale with 100 representing the most positive response. The impact of chronologic age group on HRQoL ratings was evaluated using Analysis of Variance. Spearman rank-order correlations and point-biserial correlations tested associations between demographic factors and HRQoL scores. Principal factor analysis was used to discover the factor structure and internal consistency of the preliminary CI module.
  
  
  RESULTS
  The youngest group (M=82.8) rated generic HRQoL significantly more positively than older children (8-11 years: M=75.3; 12-16 years: M=70.4). Similar significant results emerged on the overall CI module (4-7 years: M=79.8; 8-11 years: M=77.8; 12-16 years: M=71.3). The youngest group rated CI-specific items on friends and self-image more positively than older groups, but reported greater difficulties hearing teachers at school. The oldest group provided more consistent responses than younger groups on the CI module (Cronbach α=0.72). Generic and CI module scores correlated positively (r=0.19, p=.03) but this association reflects the strong correlation in the oldest group (r=0.49, p=0.0033) and camouflages non-significant results in younger groups.
  
  
  CONCLUSIONS
  Chronologic age impacts self-report of HRQoL for pediatric CI users such that younger children rate HRQoL more positively than older children and adolescents on a generic instrument and preliminary CI module. Older children provide more consistent responses on the CI module. Results support the need for further development of a CI-specific self-report HRQoL instrument.
authors.affiliation: The University of Texas at Dallas, Callier Advanced Hearing Research Center, Dallas, TX 75235, USA. warnerczyz@utdallas.edu
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Warner-Czyz
authors.forename: Betty
authors.initials: B
authors.lastname: Loy
authors.forename: Emily A
authors.initials: EA
authors.lastname: Tobey
authors.forename: Paul
authors.initials: P
authors.lastname: Nakonezny
authors.forename: Peter S
authors.initials: PS
authors.lastname: Roland
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods / Q000523:psychology; D003054:Cochlear Implants / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D011788:Quality of Life; D018570:Risk Assessment; D012649:Self Concept; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome