Validation of the Hearing Utility Measure (HUM) in Cochlear Implant Candidates and Users.

Abstract

To validate the Hearing Utility Measure (HUM), a tool designed to quantify hearing loss impact on health and quality of life for use in economic evaluation. Prospective cohort. Tertiary academic center. Cochlear implant (CI) candidates were enrolled between June 25, 2020, and March 17, 2024. Participants completed HUM alongside other assessments, including Health Utilities Index, Mark-3 (HUI-3), Speech, Spatial and Qualities of Hearing Scale (SSQ-49), Cochlear Implant Quality of Life Profile (CIQOL-35), and Tinnitus Handicap Inventory (THI) at the time of CI evaluation and 12 months post-activation. A subgroup with stable hearing status completed HUM twice, 6 months apart, to assess test-retest reliability. Among 1315 participants, HUM showed strong correlations with CIQOL-global (r = 0.69; 95% CI: 0.66-0.72) and SSQ-overall (r = 0.70; 95% CI: 0.67-0.73), supporting construct validity. HUM Tinnitus domain correlated negatively with THI (-0.75; -0.77, -0.73), as expected. Test-retest reliability was excellent (Intraclass Correlation Coefficient [ICC] 0.90, 95% CI: 0.83-0.94). HUM hearing utility was higher for candidates with single-sided deafness (SSD) (0.76) than with traditional and asymmetric hearing loss (0.58, P < .001). Median HUM improved from 0.70 to 0.78 for SSD recipients (P = .002) and 0.57 to 0.75 for traditional recipients (P < .001). HUM is a reliable, valid, and responsive measure of hearing-related health in adults with advanced hearing loss. Unlike traditional instruments such as SSQ and CIQOL, which capture patient-reported outcomes but are not designed for economic analysis, HUM is a preference-based utility instrument that enables cost-effectiveness evaluation. It outperforms the available HUI-3 by better reflecting hearing loss impact and complements existing nonutility instruments used in clinical and health policy decision-making.