Hearing Handicap Ratings Among Different Profiles of Adult Cochlear Implant Users William Noble, 1,2 Richard Tyler, 2 Camille Dunn, 2 and Navjot Bhullar 1 Objective: The aim was to compare outcomes in the domain of self-reported hearing handicap across groups of patients fit with one versus two cochlear implants (CI, CI  CI), or with an implant and a hearing aid (HA) in the nonimplanted ear (CI  HA). Design: The design was retrospective, and a prelim- inary step was to factor analyze the two measures used, namely, the Hearing Handicap Inventory for the Elderly (HHIE) and the Hearing Handicap Ques- tionnaire (HHQ). Longer versus shorter-term expe- rience with a single implant profile was compared, and further analysis confined to patients fit for less than 100 mo across the three profiles. Pre- versus postimplant self-report and performance (speech test, localization) data were also compared. Results: Three factors were identified in the HHIE, labeled Emotional Distress (HHIE), Difficulty in Hearing, and Social Restriction (HHIE). Highest handicap score for Emotional Distress (HHIE) was observed in the CI  HA group. There were signifi- cantly lower scores for Difficulty in Hearing in the CI  CI group than in the CI (p  0.02) or CI  HA (p  0.001) groups. On the Social Restriction (HHIE) subscale, the CI  CI group reported significantly lower rating than the CI (p  0.009) or CI  HA (p  0.006) groups. Two factors were identified in the HHQ, labeled Emotional Distress (HHQ) and Social Restriction (HHQ). Significantly higher Emotional Distress (HHQ) score was observed in the CI  HA group than in the CI  CI group (p  0.002); signif- icantly lower Social Restriction (HHQ) score was found in the CI  CI group than in the CI (p  0.02) or CI  HA (p < 0.001) groups. Pre-post speech test performance showed least contrast in the CI  HA group. Conclusions: Outcomes demonstrate an evident re- duction from single or bilateral implantation in the area of emotional distress and a further advantage from bilateral implantation in the areas of hearing difficulty and social restriction. (Ear & Hearing 2008;29;1– 000) It is increasingly recognized (Humes, Wilson, Barlow, Garner, & Amos, 2002; Summerfield et al., 2006) that assessment of the benefit from any inter- vention designed to reduce disability, including fit- ting of devices in the case of impaired hearing, needs to take into account the experience of the person under treatment. To this end, in recent years, the University of Iowa cochlear implant (CI) program has augmented its clinical testing protocol by adding a range of measures to assess self-reported outcomes in the domains of device performance, residual dis- abilities, and residual handicaps—the last ex- pressed in terms of emotional stress and limitations on social interaction. The focus of the present paper is to report results from two measures of handicap: The Hearing Handicap Inventory for the Elderly (HHIE; Ventry & Weinstein, 1982), and the Hearing Handicap Questionnaire (HHQ; Gatehouse & Noble, 2004). The central purpose of the present report is to compare results from the foregoing handicap mea- sures across three implant profiles: people fit with one implant, those fit with two, and those fit with an implant and who retain an acoustic hearing aid (HA) in the nonimplanted ear. Because these profiles provide quite different hearing and listening expe- riences there is good reason to appraise outcomes for patients treated in these different ways. In addition to the intrinsic value of such examination, larger questions are raised about the properties being assessed by the measures we have applied. We provide summary descriptions of pre-implant self- report and performance test data as an aid to inter- preting the postimplant self-report findings. One larger question about what is being assessed by the scales we have used, provoked especially by the use of the HHIE, concerns the concept of hand- icap, the term featured in the titles of both question- naires referred to here. The term handicap does not have universally agreed meaning and this has im- plications for assessment (Noble, 1998, p. 15–16). If different investigators take the term to refer to different domains, or define those domains differ- ently, they will end up assessing different proper- ties, yet under the same supposed rubric. As regards hearing impairment, the matter of definition could be said to have been settled by the World Health Organization (1980) that distin- guished the terms disability and handicap in the following way: disability refers to the effects of an impairment on abilities in real-world contexts, such as to hear and discriminate speech and nonspeech 1 School of Psychology, University of New England, Australia; and 2 Department of Otolaryngology, University of Iowa, Iowa. balt5/zau-aud/zau-aud/zau00108/zau3111-08z xppws S1 11/12/07 11:58 Art: AUD200208 Input-js 0196/0202/08/2901-0001/0 • Ear & Hearing • Copyright © 2008 by Lippincott Williams & Wilkins • Printed in the U.S.A. 1