CI Atlas · Audiological Evaluation · Module 16

16Self-report & functional outcome measures

A perfect score in a quiet booth and a miserable time at every family gathering can belong to the same person, which is why the evaluation cannot end at the audiometer. Validated questionnaires capture what the tests cannot: how much the hearing loss handicaps daily life, how much benefit an aid or implant delivers, how it changes quality of life, and — most personally — whether it achieves the goals the patient came in with. Used before and after intervention, and consistently across patients, these instruments turn felt experience into trackable numbers that complement the objective battery, document outcome, and anchor the counselling and expectation-setting that good care depends on. This module surveys the main tools and how to match them to the question.

FBeyond the booth

Booth scores do not fully reflect daily listening, so validated self-report instruments document handicap, communication need, benefit and quality of life — before and after intervention, and longitudinally so change is trackable.

THandicap & benefit tools

Generic hearing-handicap and aid-benefit tools include HHIA/HHIE (25 items; emotional and social/situational subscales; bands none / mild-moderate / significant), APHAB (24 items, four subscales), GHABP, IOI-HA, SADL and the SSQ (speech, spatial and qualities of hearing).

CImplant quality of life & goals

Cochlear-implant-specific tools include the Nijmegen Cochlear Implant Questionnaire (NCIQ, 60 items across physical/social/psychological domains), the CIFI, and generic utility measures such as HUI Mark III that feed cost-effectiveness. The COSI is an open, patient-nominatedgoal-setting tool used pre- and post-operatively for expectation management and to index improvement against the listener's own priorities.[2000]

CChildren & effort

Paediatric parent-report scales (MAIS/IT-MAIS, CAP 0–7, ABEL, PEACH, FAPI, ELF, LittlEARS) document functional auditory development when the child cannot self-report. And listening-effort and fatigue questionnaires add a dimension beyond recognition scores — the cognitive cost of difficult listening (the FUEL framework) — feeding the candidacy and rehabilitation discussions.[2016]

The WHO ICF framework separates three levels: body function/impairment (what the ear does — the audiogram), activity (the tasks the person can do), and participation (their life roles — the true handicap). Clinical tests sit at the impairment level, but two people with the same audiogram can have very different handicaps, so self-report questionnaires (SSQ, APHAB, HHIE, COSI) reach the activity and participation levels the audiogram cannot — capturing the disability that actually drives the decision to seek help, and to implant. Schematic.

Case 11.16 · Good scores, unmet goals

An implant user has excellent booth scores but feels the device has not helped with the one thing they wanted — conversations at work.

What tool best captures and addresses this?

Self-assessment — Module 162 questions

Question 1 · Foundation

Why use self-report questionnaires alongside booth tests?

Question 2 · Clinician

What is distinctive about the COSI?

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