The Role of Preimplantation Cochlear Implant Expectations on Postimplantation Decisional Regret and Satisfaction: A Longitudinal, Prospective Pilot Study.

introductionDespite its importance for patient care, our understanding of postcochlear implant (CI) decisional regret (DR) and satisfaction is limited. Prior research indicates that 15%-42% of patients post-CI report DR. However, the cross-sectional design of these studies limits their ability to determine patient-specific factors that identify participants at risk for DR and low satisfaction. This study aims to build on this prior research by examining factors associated with post-CI DR and satisfaction using a longitudinal, prospective study design.

methodsLongitudinal prospective study involving 15 adults with bilateral postlingual hearing loss meeting traditional CI indications. Outcome measures included: CIQOL-Expectation scores measured before CI evaluation (CIE), post-CIE, and day of surgery; CIQOL-35 Profile, CNC word scores, and AzBio sentence scores measured pre-CI and post-CI; and DR Scale and Satisfaction with Amplification in Daily Living (SADL) measured post-CI.

resultsOverall, participants demonstrated improvement in both speech recognition and CIQOL scores post-CI compared with their pre-CI abilities. On the basis of established cutoff scores, 40% of CI users had substantial (moderate or higher) DR (+DR) following cochlear implantation. Before their CIE, the +DR cohort had substantially higher CIQOL Communication expectations compared with the low DR (-DR) cohort (87.7±15.6 vs. 62.2±11.6, d =1.85). Expectations scores between the groups became more homogenous at post-CIE ( d =0.52) and trended toward similarity at the time of surgery ( d =0.26). Post-CI CIQOL-35 Communication scores for both +DR and -DR groups had no difference ( d =0.10). A similar trend of initial difference but convergence at the time of surgery were noted in multiple domains, including Emotional, Listening effort, and Global score. Although participants started with similar pre-CI CNC and AzBio scores ( d =0.11, d =0.14), the -DR group had slightly greater improvement in speech recognition scores, however, with substantial outcome variability ( d =0.63, d =0.74). There were no differences in age at implantation or duration of hearing loss between DR groups, but the -DR group had a higher percentage of females (78% vs. 33%) compared with +DR. Similar results were observed when using low versus high satisfaction (SADL) scores as an endpoint.

conclusionThis pilot study suggests that expectation-outcome misalignment, particularly higher expectations before CIE, is a key driver of post-CI regret and dissatisfaction. Given prior research indicating that pre-CI expectations are modifiable, these findings, when confirmed in an expanded sample, may provide support for early interventions and counseling to set more realistic expectations for patients at high risk for DR and low satisfaction. LEVEL OF EVIDENCE: Level II.