The Bone-Anchored Hearing Aid Quality-of-Life Assessment Myrthe K. S. Hol, MD; Marian A. Spath, MSc; Paul F. M. Krabbe, PhD; Catharina T. M. van der Pouw, MD, PhD; Ad F. M. Snik, PhD; Cor W. R. J. Cremers, MD, PhD; Emmanuel A. M. Mylanus, MD, PhD Objectives: To assess the impact of a bone-anchored hearing aid (BAHA) on the quality of life (QOL) of adults and to test the hypothesis that a BAHA improves QOL because otorrhea and/or skin irritations decrease. Design: Prospective postal-based questionnaire study using validated health-related QOL instruments, com- bined with hearing-aid–related questions. Patients and Methods: The study included 56 con- secutive adult patients with acquired conductive or mixed hearing loss who were scheduled for BAHA implanta- tion at the University Medical Centre Nijmegen, Nijme- gen, the Netherlands. All 56 patients completed the 36- Item Short-Form Health Survey (SF-36), the EuroQol-5D (EQ-5D), and the Hearing Handicap and Disability In- ventory (HHDI); 36 patients had been using an air- conduction hearing aid (ACHA) and 20 patients a con- ventional bone-conduction hearing aid (CBHA). Questionnaires were filled out before surgery and after 6 months of experience with the BAHA. Results: In the SF-36 group, there was significant improvement in the scores of the mental health domain ( P =.02). When the SF-36 patients were classified according to previous hearing aid, there was no statisti- cally significant change in the scores in any of the domains. In the EQ-5D group and in its ACHA and CBHA subgroups, there were no important differences in the results before and after the patients received their BAHAs. In the HHDI group, the handicap and disability scales showed significant improvement (P.01) irrespective of the type of previously worn hearing aid. Conclusions: Overall, generic health-related QOL was not influenced significantly by the use of a BAHA according to the SF-36 and the EQ-5D. The more disease-specific scales (HHDI) did show improved QOL with a BAHA. Arch Otolaryngol Head Neck Surg. 2004;130:394-399 S EVERAL CLINICAL STUDIES have evaluated surgical and audiometric outcomes with the bone-anchored hearing aid (BAHA). 1-4 It has been shown that the percutaneous coupling of the BAHA to the skull is safe and stable over time. Furthermore, these studies have consistently shown that the audiological results are superior to those obtained with conventional bone conductors and, al- though less convincingly, with air- conduction hearing aids (ACHAs). 1-4 Because a surgical procedure is in- volved, and the financial costs are rela- tively high, it seems more important to evaluate subjective appraisals in studies in which conventional hearing aids were replaced with a BAHA. Most studies 2-8 that reported subjective assessments of patients fitted with a BAHA used ques- tionnaires with items concerning the pa- tient’s attitude toward the new hearing aid itself or the patient’s performance in various listening situations and condi- tions. The questionnaires compared the BAHA with conventional hearing aids, and, again, the results favored the use of the BAHA. 5-8 The importance of patient outcome research is becoming increasingly recog- nized, and a number of recent studies 9-11 have focused on quality-of-life (QOL) is- sues. Instruments used to obtain out- come measurement after hearing aid fit- ting vary in length and internal structure. Use of an appropriate instrument is es- sential to obtain valid and clinically mean- ingful measurement of outcome. Fre- quently used instruments quantify disability and handicap as well as benefit and health status. In most studies, a sig- nificant reduction in hearing disability and handicap was noted, while Dutt et al 9 and other authors 10,11 reported improved QOL. 9 All data collection in these studies can be ORIGINAL ARTICLE From the Departments of Otorhinolaryngology (Drs Hol, van der Pouw, Snik, Cremers, and Mylanus) and Medical Technology Assessment (Ms Spath and Dr Krabbe), University Medical Centre Nijmegen, Nijmegen, the Netherlands. The authors have no relevant financial interest in this article. (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 130, APR 2004 WWW.ARCHOTO.COM 394 ©2004 American Medical Association. All rights reserved.