Listening Fatigue Contributes to Hearing-Related Quality of Life in Adult Cochlear Implant Candidates.

OBJECTIVE: To identify factors independently contributing to preoperative hearing-related quality of life (HRQOL) in adult cochlear implant (CI) candidates. STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: Tertiary academic medical center. PATIENTS: A total of 171 adults were evaluated for CI candidacy from 2018 to 2024. MAIN OUTCOME MEASURES: Cochlear Implant Quality of Life-10 Global (CIQOL Global) scores served as the main outcome measure. Independent variables included the 10-item Vanderbilt Fatigue Scale (VFS-A-10), Tinnitus Handicap Inventory (THI), age, duration of deafness, and preoperative AzBio sentence recognition in quiet (AzBioQ) scores. RESULTS: Bivariate analyses revealed significant correlations between CIQOL Global scores and both VFS-A-10 (r=-0.56, P<0.001) and THI (r=-0.31, P=0.005). No significant correlations were found between CIQOL Global and age, duration of deafness, or AzBioQ performance. In multivariable linear regression (n=67), VFS-A-10 was the sole independent predictor of preoperative CIQOL Global (β=-0.55, P<0.001). THI, age, duration of deafness, and AzBioQ performance did not contribute additional explanatory value. Sensitivity analysis in a larger sample of adult CI candidates (n=144) confirmed these findings. CONCLUSIONS: Listening fatigue was the primary independent factor associated with preoperative HRQOL among CI candidates, whereas traditional audiologic measures and perceived tinnitus did not contribute independently. These findings highlight the importance of assessing listening fatigue as part of CI candidacy evaluation and suggest that interventions targeting fatigue management may improve patient well-being. Routine assessment of listening fatigue could enable more personalized counseling and identify CI candidates who might benefit from earlier intervention.