Preferred Name

Bonnie A. Purtill

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation


Document Type


Degree Name

Doctor of Audiology (AuD)


Department of Communication Sciences and Disorders


Yingjiu Nie

Ayasakanta Rout

Lincoln Gray

Stephanie Moody


Unmanaged hearing loss can have profound cognitive, social, and emotional impacts on a person’s life. Cochlear implants improve functional skills such as auditory detection and speech discrimination, and have also been shown to improve quality of life. Health related quality of life (HRQoL) measures are a great tool to assess mental, physical, and social changes after cochlear implantation. While previous research has established improvement in HRQoL after cochlear implantation, there remains a lack of research evaluating long-term effects of cochlear implants for post-lingually and bilaterally deafened adults. Using a disease specific HRQoL questionnaire—Nijmegen Cochlear Implant Questionnaire (NCIQ) and a social hearing questionnaire—Performance Inventory for Profound and Severe Loss (PIPSL), this study aims to evaluate the changes in social functioning and active communication skills over the course of 24 months.

Data for this study was collected using a Cochlear Implant Database, an institutional IRB-approved data registry that includes audiological data, clinical data, surgical details and quality of life survey data. Twenty-one bilaterally, post-lingually deafened patients with a unilateral cochlear implant were included in this study. They completed either the NCIQ or the PIPSL questionnaire at four timepoints, including preoperatively, 6 months-, 12 months-, and 24 months post-activation. Nineteen patients completed both the NCIQ and the PIPSL. Social functioning is evaluated using the combined responses to activity limitations and social interaction subscales within the NCIQ. Active communication skills is used to describe two subscales of the PIPSL including response to auditory failure and understanding speech with visual cues.

Friedman tests revealed that social functioning in the NCIQ and active communication skills in the PIPSL both significantly improved following cochlear implantation. While the improvement in both domains saturated at 6 months post-activation, their subdomains saturated at different timepoints. Social interaction reached its maximum improvement at 12 months while activity limitations reached it largest improvement at 6 months. Additionally, understanding speech with visual cues saturated at 6 months, where response to auditory failure reached maximum benefit at 24 months. Spearman’s rank-order correlation revealed a positive correlation between social functioning and both domains of active communication skills

The results in this study conclude a long-term improvement in social functioning and active communication after cochlear implantation. While majority of benefits saturate at 6 months post-activation, improvement is overall maintained over the course of 24 months. The improved HRQoL from cochlear implantation may be partially attributed to the improved active communication skills which involve not only making use of understandable auditory and visual-auditory contents, but also management of communication when these contents may not be understandable

Available for download on Wednesday, May 08, 2024