Bone conducting hearing implant

1. WELCOME TO THE 21st
JOURNAL CLUB CONFERENCE
OF-
2022-2023

2. JOB SATISFACTION AND QUALITY OF LIFE IN ADULTS
USERS OF BONE CONDUCTION HEARING DEVICES
PRE- AND POST-IMPLANTATION:A 1 YEAR FOLLOW
UP STUDY.
PRESENTED BY- MISS ZAREEN
AHAD
BASLP 6TH SEMESTER,
ROLL NO-21
GUIDED BY- MR RAJ SHEKHAR
ASSISTANT PROFESSOR OF
AUDIOLOGY
INSTITUTE OF HEALTH
SCIENCES
AUTHOR- HÅKAN HUA & AARAN T. LEWIS

3. INTRODUCTION:-
◦ Hearing impairment (HI) is the most frequent sensory deficit in humans
and it is estimated that by 2050 nearly 2.5 billion people will be living with
some degree of hearing loss (Chadha,Kamenov, and Cieza 2021).
◦ Health-care professionals are frequently consulted by individuals with HI
who experience diffi-culties at work, and studies have shown that HI,
regardless of type and degree of hearing loss, is associated with poorer
quality of life (Ringdahl and Grimby 2000; Gellerstedt and
Danermark2004; Hua et al. 2013).

4. ◦ Bone Conduction Hearing Devices (BCHDs) are systems that use the natural
process of sound travelling through the bone and soft tissue directly to the cochlea
◦ BCHDs consist of an external sound processor that captures and processes sound
which is then converted into mechanical vibrations. These vibrations are transmitted
to an implant that is anchored to the skull bone, through which they are further
conducted to the cochlea.
◦ BCHD are an effective method of hearing rehabilitation for people with a conductive
hearing loss (CHL) or mixedhearing loss (MHL), as they bypass any limitations on
sound transmission associated with pathologies or anomalies of tth Midd outer or
middle ear (Ellsperman et al. 2021).
◦ These devices can also help patients who suffer from single-sided deafness (SSD) by
transmitting sound received on the deaf side directly to the hearing cochlea
(Hampton et al. 2022).

5. ◦ BCHDs bypass the conductive part of the hearing loss and, as such,
inherently close the air-bone gap.
◦
◦ High levels of satisfaction in relation to sound amplification and speech
perception when using BHCDs have been reported in patients with CHL
or MHL (Hua, Goossens, and Lewis 2022).
◦
◦ A recent health technology assessment also concluded that BCHD
improve functional, and patient reported outcomes in adults and children
with CHL/MHL and SSD(Ontario Health (Quality) 2020).

6. ◦ https://youtu.be/iU0BcOf6Vq8

7. REVIEW OF LITERATURE
Granberg and Gustafsson
(Granberg and Gustafsson
2021), it is reported that
people with HI show
increased unemployment,
early retirement due to poor
health, and a higher degree
of sick leave when compared
to the population at large.
Research reported that these
employees have lower quality of
life, reduced participation, social
isolation and problem at
workplace.
Results showed that most of
them were aware of difficulties
perceived at work such as group
chats, loud noises, tinnitus, had
a direct negative impact.
The most common feeling was
sense of exclusion both at work
and home.

8. AIM OF THE STUDY:-
The aim of the study
was to compare job
satisfaction and health-
related quality of life
(HRQoL) in working
age adult users of
BCHD pre-
implantation and post-
implantation at 12-
month follow-up
A second aim was to
examine the subjective
assessment of
functional hearing pre-
and post-implantation
in the same population.

9. OBJECTIVES:-
Hearing loss is a growing public health issue that impacts both health related
quality of life and working life.
This study investigates how hearing rehabilitation with bone conduction
hearing implants impacts health related quality of life and working life in
adults of working age with hearing impairment.

10. METHODS:-
Used retrospective data collected as a part of Cochlear IROS, prospective repeated measure that
uses subjective tools- Health Utilities Index 3(HUI-3) and Speech Spatial Qualities of hearing
scale(SSQ).
Included all patients of working age (18–65 years old) who were implanted with a bone conduction
hearing aid and provided baseline and 12-month follow-up data for HUI-3, SSQ, and complete
questionnaire data regarding employment status.
Included all patients of working age (18–65 years old) who were implanted with a bone conduction
hearing aid and provided baseline and 12-month follow-up data for HUI-3, SSQ, and complete
questionnaire data regarding employment status.

11. Study Population:-
There were total 1506 patients, implanted with hearing device, out of these 352
we’re implanted with BCHD
HUI Baseline data was available of 252 patients , 76 out of these patients had 12-
month follow-up HUI-3 data available and 12 patients were missing SSQ data at
follow-up, so they were excluded.
Out of 63 remaining patients,20 were excluded- they were retired or not of
working age leaving 43 patients.

12. QUESTIONNAIRES USED:-
SSQ- Speech
Spatial
Qualities
Employemen
t and Job
satisfaction
questionnaire
HUI-Health
Utilities
Index mark-
3

13. HEALTH UTILITIES INDEX
MARK-3
General HRQoL was measured using HUI-3 consists of 15
items covering 8 health dimensions: vision, hearing, speech,
ambulation, dexterity, emotion, cognition and
complaints(Horsman et al). Utility values ranges from -0.
36(worse) to 1(perfect).

14. SPEECH SPATIAL AND QUALITIES OF
HEARING SCALE (SSQ)
SSQ- self-report test of auditory disability consisting of 49
items that question the listner’s abilities in many complex
listening situations of real life. It is widely used tool in hearing
research. This comprises 14 scored items including speech
hearing 17 items on spatial hearing and 18 items on other
qualities and features of hearing.

15. EMPLOYMENT AND JOB
SATISFACTION
Questionnaire covered vocational and employment opportunities at baseline and at 12
months follow-up. It captured whether they are engaged in full time Or part time
work, in education, or retired and also captured whether the patient’s hearing abilities
impacted their ability to perform their job satisfactorily.
Patients were asked whether they felt that their hearing ability had a negative effect
on their ability to do their daily work which scored 1- not at all ,2-sometimes, 3- most
of the time, 4- always.
At follow-up they were asked whether their hearing device had a negative effect on
their ability to do their work satisfactorily.

16. STATISTICAL
ANALYSIS
The IBM, SPSS software package was used for statistical analysis
Differences in HUI-3 and SSQ scored were analysed using the Wilcoxon
Signed-Rank Test
Employment impact scores, pre and post implantation, we’re analyzed by Mann-Whitne
Test.
Effect size were calculated according to Cohen’s D-(0.2-small size), (0.5-medium), (0.8-
large)
Spearman Rank Order Correlations Rs were used to examine for correlations between
employment, quality of life, and hearing disability out-comes.

17. Results- Demographics
43 patients completed the HUI-3 pre-implantation and 43 of these
completed the questionnaire at 12 month follow up, post-
implantation. Regarding SSQ, all 43 patients completed the SSQ
pre-implantation and at 12 month follow-up point.
The mean age of subjects was 39.5 +/- 14.8( range-18. 1-64.5) and 26 we’re
mal and 17 we’re female
Regarding job satisfaction, 30 of the 43 patients with HUI-3 and SSQ data
completed the patient questionnaire pre-implantation and 12 month follow
up post implantation.

18. HUI RESULTS:-
Mean attribute score for all attributes other than emotion and cognition improved
between baseline and follow up.
Mean utility score was also increased. Statistically significant mean
improvement in hearing attribute(p=0.003) and speech attribute(p=0.003)
A statistically significant mean improvement in global score was reported
between baseline and follow-up and effect size was small(d=0.269)

19. SSQ RESULTS:-
Mean speech domain score improved and was statistically significant
(p<0.001)
Mean spatial domain scores also improved and was statistically significant
(p<0.001).
Mean qualities of hearing domain scores improved and this change was
statistically significant.
Mean global SSQ score was improved and was statistically significant .

21. Employment and Job satisfaction
At Baseline hearing situation on their work- 2.48(1.06), indicating that on avg
their hearing impacted their working sometime/most of the time.
At follow-up patients scored their mean impact of hearing on their work at
1.40(0.72) indicating that on average their hearing impairment negatively
impacted their working ability not at all/ sometimes. Difference of mean
score of 1.08 and effect size was very large (d=3.47)
22/30 patients reported that their hearing device allowed them to perform
their employment much better at follow-up and only a single patient
reported a deterioration in performance at work.

22. Correlation between Employment, HRQoL
and Hearing Disability:-
• Spearman’s rank order was run to determine the relationship
between job satisfaction and SSQ and HUI-3 scores.
• Moderate, positive correlation, between SSQ and job
satisfaction, statistically significant ( p=0.008)
• Weak, positive correlation between job satisfaction and SSQ
speech(, p=0.222)
• SSQ global score-(, p=0.104)
• HUI-3 hearing attributes=(, p=0.196)
• HUI utility score=( p=0.221)

23. Discussion:-
HUI-3 data showed statistically significant and clinically important
improvements in comprehensive health state and hearing and speech
attributes post-implantation of the BCHD. This was supported with the
findings of the SSQ questionnaire, where statistically significant and
clinically important improvements in all domains were observed between
pre- and post-implantation
.
The results also revealed that job amenability improved after BCHD
implantation. The findings of the current study are interesting since data
demonstrates that, in addition to improved hearing and HRQoL, BCHD
implantation can also have a positive impact on job satisfaction for users
of working age.

24. Limitations:-
• First-concerns have previously been raised regarding
generic HRQoL since these may lack the necessary
sensitivity to identify the consequences os HI.
• Second- study only examined change in job
satisfaction,HRQoL and subjective hearing in limited
group of BCHD user who are healthy and working. It did
not control each respondents daily work environment.
• Third- patients only recorded data over a follow up of 12
months, hence not possible to predict whether the post
implantation effect is stable over the long term.

25. FUTURE RESEARCH:-
Future research should examine the similarities/differences
between employees with conventional hearing aids, BCHD
and/or cochlear implants.
Additional research focusing on topics such as the need for
recovery after work, perceived effort/problems in different
work situations/noises and strategies to manage working
life in BCHD users would also be of interest.

26. CONCLUSION:-
Hearing rehabilitation with BCHD reduces hearing disability and
improves HRQoL for recipients, resulting in significant improvements
across all domains assessed with the SSQ and a clinically important
utility gain of 0.086 between pre-implantation and 12- month follow-up
as measured with the HUI-3.
Additionally, 73.3% of patients in this study performed much better at
word post-implantation, supporting the conclusion that implantation
with BCHD reduces the negative burden hearing loss places on one’s
ability to carry out their employment, resulting in signifi-cant
improvements in working ability and job satisfaction.

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