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How Many Years Would You Give Up for Better Hearing?

Before you attempt to answer this question, think of another one: what does the phrase quality of life mean to you? And, do you even know how to define it?

If you are a healthy person you may interpret it as the freedom and ability to pursue and enjoy whatever lifestyle and activities you choose, without any obstacles in your way. But if you suffer from an ailment that impairs or limits that ability a hearing loss, for example -- you may not be enjoying your life to the fullest.

Why is so much attention given to the issue of health-related quality of life (HRQoL) in the first place? The debate reflects the changing mores and the growing awareness, as well as the openness with which individuals and society now look at the issues related to the quality of our lives. The discussion of quantity vs. quality is a fairly recent phenomenon, says Harvey Abrams, PhD, Chief of Audiology and Speech Pathology Service at the VA Medical Center in Bay Pines FL, who conducted research into HRQoL instruments that measure the impact of a hearing loss on a patients mental and physical well-being. There is a shift away from how long one lives to how well. Patients often perceive the treatment of a disease as being worse than the disease itself, and sometimes they question whether the treatment is worth it, given the impact of that treatment on their quality of life.

Of course, the HRQoL issue is not limited to hearing impairments only, or, for that matter, to any one specific disease. It is relevant to any illness or condition, which significantly impacts our health.

Tracking HRQoL
Can a concept that is difficult to define be accurately measured? And if so, how?

Finding out how a medical condition or treatment affects ones quality of life is not easy since people dont always agree on what quality of life means, Dr. Abrams concedes. Also, two people will not necessarily react to the same disease similarly.

There are, however, various techniques used by researchers like Dr. Abrams to assess an individuals self-perceived health status to better understand how chronic illness interferes with a person's day-to-day life. They measure the effects of various disorders, short- and long-term disabilities, and diseases in different populations. Why is this important? Because tracking health-related quality of life can determine what interventions are needed, and how the scarce public funds should be dispersed.

Traditional methods used in audiology to assess the impact of a hearing impairment, Dr. Abrams says, would be to determine how well the speech recognition performance improved by measuring the percentage of correctly repeated words following a fitting of a hearing aid. The method, however, was not infallible. What we discovered, Dr. Abrams says, is that improvement in speech recognition measured in the clinic does not translate to improved communication ability as perceived by the patient. As a result, we now use questionnaires that measure the extent to which hearing aids improve our patients ability to function in specific situations.

Trading-Off For Better Life
Imagine a hypothetical situation where you are told that you have 10 years to live with severely impaired hearing, or you can choose to give up a few of those years in exchange for perfect hearing, allowing you to enjoy the activities you currently cannot. How many years would you be willing to trade off for good health and an enhanced quality of life that comes with it?

This is what the Time-Trade-Off (TTO) technique does: it measures how much time a patient is willing to give up for better health. The patient is offered an option of choosing a normal life span in his or her present health condition, or a shortened life expectancy with perfect health in this case, perfect hearing. The researcher reduces the life span spent with the perfect hearing until the patient is indifferent between the shorter period of perfect health / hearing and the longer period in an impaired state.

Obviously, the greater the impact of the disorder on the persons perceived quality of life, the more years they would be willing to give up to be free of that disorder, Dr. Abrams says.

And, while not all diseases are equal in terms of pain or discomfort, all of them diminish in some way the sufferers ability to enjoy life. As for the hearing disability, we know from research involving cochlear implant patients that severe to profound hearing loss can have a very significant impact on quality of life, Dr. Abrams says. The research that has incorporated TTO measures does not focus on absolute years of life, but compares the TTO measure into what is known as a utility score, used to compare the effects of different disorders, treatments, and the cost of achieving benefit across different disorders and treatments.

Prioritizing Health Choices
The good news is that, given the advances in hearing technology and in medicine in general you will likely never have to a make a difficult choice between good health and long life. People dont have to choose between the two, Dr. Abrams says. The purpose of having them choose is a research technique to determine how hearing loss impacts their quality of life as compared to heart disease, diabetes, depression or other diseases.

At the end of the day it is as much about health-related quality of life as it is about cost-effectiveness. If, as society, we decide to ration health care as we currently do through Medicare and Medicaid we need to know which diseases we should cover and which we cant, Dr. Abrams says. Knowing how our society rates diseases in terms of their impact on quality of life is one way we may want to make these rationing decisions.

And that is one trade-off money versus quality of life that no patient wants to make.

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