Journal of Otology & RhinologyISSN: 2324-8785

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Research Article, J Otol Rhinol Vol: 4 Issue: 6

Satisfaction Level According to the SADL in Patients with EAS Cochlear Implant

Luciane Calonga1, Alexandre Caixeta Guimarães2, João Paulo Peral Valente2, Arthur Castilho2, Walter Adriano Bianchini2,Agrício Nubiato Crespo2, Guilherme Machado de Carvalho2*
1Audiologist, Cochlear Implant Specialist, Audiology and Implantable Ear Prostheses Ear, Nose, Throat and Head & Neck Surgery Department, Brazil
2ENT, Otologist Doctor, Otology, Audiology and Implantable Ear Prostheses Ear, Nose, Throat and Head & Neck Surgery Department, Brazil
Corresponding author : Dr. Guilherme Machado de Carvalho
Otology, Audiology and Implantable Ear Prostheses, Ear, Nose, Throat and Head & Neck Surgery Department UNNICAMP, Brazil, PO Box 6111, Postal Code: 13081-970, São Paulo, Brazil
Tel: +55 19 35217523; Fax: +55 19 35217563
E-mail: [email protected]
Received September 27, 2015 Accepted October 20, 2015 Published October 29, 2015
Citation: Guimarães AC, Valente JPP, Castilho A, Bianchini WA, Crespo AN, et al. (2015) Level of Satisfaction According to the SADL Questionnaire in Patients Undergoing Hybrid Cochlear Implant. J Otol Rhinol 4:6. doi:10.4172/2324-8785.1000254

Abstract

Background: Hearing Loss (HL) is one of the most common disorders that affects people. The positive impact of the use of cochlear implants in the lives of the hearing impaired is demonstrated in several studies.
Objective: Evaluate the level of satisfaction of patients undergoing hybrid crawl implant by applying the SADL questionnaire.
Methods: Clinical study including 14 patients implanted with the brand MED-EL FLEX EAS in a tertiary hospital in the last three years.
Results: Fourteen subjects were selected initially for the study, but only 13 reached all inclusion and exclusion criteria according to our methods. There are 5 males and 8 females patients. The average age of the patients, at the cochlear implant surgery moment, were 44.7 years old.
Conclusion: Positive effects were very high, with very low negative factors, costs or negative effects on personal image of the patients, indicating that cochlear implantation was very good for these patients.

Keywords: Hearing loss; Hearing loss, High-frequency; Cochlear implants; Patient satisfaction

Keywords
Hearing loss; Hearing loss; High-frequency; Cochlear implants; Patient satisfaction
Introduction
Hearing Loss (HL) is one of the most common disorders that affects people in developed societies and the rehabilitations is possible through the use of hearing aids and cochlear implants. The adaptation of hearing aid and cochlear implant involves many subjective and psychosocial factors and learning to evaluate them can make this process easier and faster to users [1-6].
It should clearly inform patients that the devices do not restore normal hearing, but will function as an aid to achieving a greater number of acoustic information and the auditory rehabilitation work should be introduced as soon as you start using the device. The positive impact of the use of cochlear implants in the lives of the hearing impaired is demonstrated in several studies and satisfaction questionnaires have been included as one of the variables to be considered [1-6].
The objective of this study is to evaluate the level of satisfaction of patients undergoing hybrid cochlear implant (electroacoustic stimulation) by applying the SADL questionnaire.
Methods
It was conducted clinical study including 14 patients implanted with the brand MED-EL FLEX EAS in a tertiary hospital in the last three years.
All patients used the internal component SONATA TM model and have been adapted by Maestro System TM software. Patients who had postoperative electro acoustic stimulation used speech processor DUET 2 Tim.
Patients with incomplete data, which did not meet the inclusion criteria or who would not be subject to such assessment were excluded from this Protocol.
Audiological evaluation
Audiological tests were performed including impedanciometry, speech and pure tone audiometry. The tests were performed using an audiometer AC30-SD25, calibrated according to ISO 389 standards / 64.
The OAEs distortion products were performed at frequencies 700 to 8000 Hz with stimulus at 65-55 dB SPL, with a frequency ratio of 1.22. OEA was considered present when the signal / noise ratio was greater than 6 dB, and with reproducibility greater than or equal to 70%.
The tests from the ABR and CM were performed with insert earphones. Stimulus of 100 dB HL was used for the ABR covered with frequencies between 250 and 8.000 Hz, with duration of 100 microseconds, and condensed and rarefied polarities. The abnormality of ABR was defined as absence of wave formation or severe changes in morphology of the same with up to 100 dB HL stimulus.
The CM was evaluated in tests from the ABR, with the feature of inverting the polarity (condensed and rarefied). When CM was positive with stimuli of 100 dB HL electrophysiological threshold, in decreasing order was researched.
For ABR, which were repeated at least two times, the device AT- 235 (Interacoustics) was used.
Hearing loss impairment was classified through audiometry stratification in mild, moderate, severe / severe or profound hearing loss [7].
Speech perception tests: During preoperative evaluation, all subjects underwent to a speech perception test on the same day of their surgery. The speech perception test is based on several studies in English language, adapted and developed for Portuguese language by Bevilacqua et al. [8]. Patients performed the tests with hearing aids, in a quiet and peaceful place (best aided condition).
Postoperatively, all subjects repeated the speech perception test at least one year experience with cochlear implant. The tests were performed using the cochlear implant (CI). The same audiologist performed all tests (pre-and postoperative).
Subjective evaluations: When the patients did their postoperative speech tests it were asked to rate the quality of their experience with CI compared to last year on a Likert scale ranging from 0 to 10, similar to the visual analog scale. A score of 0 indicates that user intervention regretted not recommend to others, and felt he / she had been better in the past, with their hearing aids. A score of 10 indicates that the user was completely satisfied with the work and highly recommended.
SADL (Satisfaction with Amplification in Daily Life)
The questionnaire SADL (Satisfaction with Amplification in Daily Life) was selected to evaluate this sample. It was translated into Portuguese and adapted to our cultural aspects by Mondelli et al. and validated by the study of Danieli et al. The questionnaire results in an overall satisfaction score and a profile of subscales that address positive effects, service and value, negative characteristics and personal image [9,10].
SADL was prepared in order to assess overall patient satisfaction with the use of a hearing aid. By identifying the factors that contribute to satisfaction and to try to confirm these attributes to the processes involved, this test has the potential to qualify and analyzes the quality of health services [9-12].
The SADL has 15 questions, divided into 4 subscales, reflecting overall satisfaction.
Positive effects: Six items related to acoustic and psychological benefit.
Service and value: Three items related to professional competence, product price and number of repairs.
Negative factors: three items relating to environmental noise amplification and phone use.
Personal image: Four items related to aesthetics and the stigma of hearing aid use [11,12].
Items are rated such that satisfaction is reflected by the high score. A score is generated for each of the four subscales and each subscale score is computed from the average of the answers to your questions.
To answer 15 questions a scale of 7 points from the same period, which corresponded to a categorical scale from “not at all” to “very much” satisfied was used. For 11 questions, “very much” indicated total satisfaction and was scored 7, on the other hand “not at all” indicated complete dissatisfaction and was scored 1.
The other four questions were inverted, where “very much” indicated complete dissatisfaction, and scored 1 and “not at all” indicated overall satisfaction, and scored 7 [11,12].
Statistical analysis
The data were analyzed using descriptive analysis, with production of means, medians, standard deviation tabs.
Chi-Square was used to compare the groups of our sample. Because of the small size of some of the variables analyzed Fisher’s Exact test was also used to check the correlation between the groups.
The confidence Interval was of 95%, and p-value <0.05 was considered significant.
Ethical considerations
The institutional review board approved this study and all subjects gave written informed consent. The survey was conducted considering ethical, and was approved by the Ethics Committee under protocol number 24802914.8.0000.5404.
Results
Fourteen subjects were selected initially for the study, but only 13 reachead all inclusion and exclusion criteria acording to our methods. There are 5 males and 8 females patients.
The average age of the patients, at the cochlear implante surgery moment, were 44.7 years old. The results of satisfaction are described in Table 1.
Table 1: SADL results.
Discussion
The grade of patient satisfaction with use of your device either through conventional electrical stimulation or electro-stimulation of the cochlea, is of utmost importance in their quality of life. Accordingly, the SADL scale is short and short enough and at the same time extensive enough to permit a proper evaluation of a multidimensional variable. However, as already described by Cox et al [COX], more studies are needed to refine their understanding and their properties in test and retest and determine the clinical applicability, scientific and administrative of their results [13].
Although the benefits of cochlear implantation are well established and demonstrated, Its cost-effectiveness must be taken in consideration. The device is more expensive than other forms of hearing rehabilitation, which can limit its use at the public health system. In some cases, patients who could benefit from this technology have to wait a considerable time to undergo surgery, once they cannot afford the procedure in a non-public hospital. We hope that in a near future, with the spread of this technology, it can become less expensive and more accessible over time [14,15].
Cochlear implants can positively impact the life of hearing impaired subjects and this is demonstrated in multiple papers. Satisfaction survey through questionnaires have been considered for evaluated those positive effects [2,3,5,6].
The CI procedure is a safe surgical technique for rehabilitation of severe to profound sensorineural hearing loss but not free of complications, although the complication rate is low. These complications have been a reason for concern in health care centers during the implementation of new surgical approaches and can be divided into minor and major complications. The minor complication rate is significantly higher in the adult population, but major complication rate is similar both for children or adults [16,17].
Minor complications include transient peripheral facial palsy, posterior meatal wall injuries, annulus and tympanic membrane injuries, perilymphatic fistula, bleeding, corda tympani nerve injuries, and hematoma. Major complications include electrodes problems (misplacement, damage, inserting problems compression of electrodes, dislocation), flap dehiscence or infection, cholesteatoma, otomastoiditis, facial palsy with sequela, CSF leak, meningitis and incapacitating otological symptoms [16,17].
SADL is a questionnaire that was developed to evaluate the degree of satisfaction attributed to a hearing device for people with hearing disorders. This questionnaire evaluates many factors and is very useful to define how the patient is satisfied in daily life situations after the use of a hearing device. In this study the SADL was used to evaluate the satisfaction of patients with preservations oh hearing thresholds in low frequencies and treated with EAS, the results showed that the positive effects were very high, with very low negative factors, costs or negative effects on personal image of the patients, indicating that cochlear implantation was very good for those patients.
Conclusion
Positive effects were very high, with very low negative factors, costs or negative effects on personal image of the patients, indicating that hybrid cochlear implantation was very good for those patients trough SADL analysis.
Acknowledgments
We would like to thank all our patients and their families. We also wish to thank all of our ENT service and those who have contributed directly and indirectly to the realization of this study. Special thanks to Dr. Igor Hazboun and Dr. Thiago Zago.”
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