Why are PROMs important? How do you use them in your clinic? 

Patient reported outcome measures (PROMs) are useful in evaluating people with hearing loss as a whole person. Audiograms give us a very small picture into the life of a person who has hearing loss. Often that picture is not representative of the struggles that person endures on a daily basis. Our diagnostic testing, while valuable, often doesn’t fully represent the real-life implications of living with significant hearing loss. People with significant hearing loss may have issues with social situations that are stressful to navigate.

‍

Quality of life is known to be significantly negatively impacted in people with hearing loss. This is a critical measure to complete prior to intervention and post-intervention, in order to demonstrate if the options recommended actually had the intended improvement. In other words, does the cochlear implant actually reduce social isolation, improve communication interactions, reduce stress, and improve overall quality of life? When we measure with tonal stimuli in a controlled environment like a sound treated soundbooth, and we don’t look at how a patient perceives their journey to be, we are missing the person, and just treating the hearing loss. The whole person is who matters if we are truly to deliver patient centered healthcare.

‍

The Minimum Speech Test Battery – 3 (MSTB-3) recommends the use of two PROMs for candidacy evaluations and post-operative assessments of performance. They include the CI-QOL 10 Global and the SSQ-12. The CI-QOL 10 Global stands for the Cochlear Implant Quality of Life global measure and was developed to provide a functional assessment in adult cochlear implant recipients. The SSQ-12 is a tool designed to help round out behavioral assessment of hearing functionality. The SSQ-12 stands for the Speech, Spatial and Qualities of Hearing scale in a 12-item version. People with hearing loss report on how their hearing loss meaningfully impacts their ability to function in the world around them, not just how they function in the controlled environment of a sound treated soundbooth. Additionally, for those individuals who are negatively impacted by debilitating tinnitus, the Tinnitus Handicap Inventory (THI) questionnaire is also recommended. This can evaluate individual difficulty with regard to tinnitus and specific needs of those that suffer from this condition. Additionally, it can be utilized as a post-operative measure to evaluate change from the intervention of cochlear implantation.  

‍

These measures aid clinicians and professionals in determining how their hearing loss is really causing difficulty in their lives, and how we may better serve their hearing needs with technology and recommendations. Without them, we are not looking at them as a whole individual who has specific needs. We all have different lives, different communication needs, different occupations, and our evaluations need to reflect those differences in order to better hone our treatment options to successfully meet the hearing needs of those we have the privilege of caring for in implant programs.  These three specific PROMs were selected as they were found to be more sensitive to the difficulties people with significant hearing loss were experiencing, and how cochlear implantation may improve their experiences after implantation. Other PROMs were considered in the development of the MSTB-3 and may be useful for specific patients; however, these three were found to be the minimum recommended PROMs. Insurance may require additional information regarding the recommended treatment of cochlear implantation and these PROMs have been helpful in clearly identifying difficulties experienced by individuals beyond the soundbooth; potentially aiding in insurance coverage of the life changing treatment of cochlear implantation.