Introducing: The Quality of Life in People With Hearing Loss Questionnaire

Clinicians and researchers can use the new “Quality of Life in People with Hearing Loss Questionnaire (HL-QoL)” to assess how hearing loss and treatment affect an individual’s quality of life. As the first validated questionnaire based on the WHO’s international classification of functioning, disability, and health, it is designed to assess hearing outcomes while providing a holistic perspective.

A medical professional wearing a white lab coat and stethoscope sits at a desk, speaking with a hearing loss patient who is seated across from them. The doctor holds a pen over a clipboard with papers, which is a quality of life questionnaire. A tablet and an open laptop rest on the desk. A white cup and various office items are visible in the background, creating the setting of a bright, modern medical consultation room.

Hearing aid and cochlear implant technology have rapidly advanced in the last two decades, yet the assessment of hearing-related quality of life (QoL) has not.

The expectations and hearing outcomes achievable with cochlear implants have changed dramatically since 2000 when the Nijmegen Cochlear Implant Questionnaire (NCIQ) was developed.[6] The NCIQ—with its 60 items related to hearing abilities and challenges in various listening situations—still remains the most widely used measure of QoL in CI recipients.[4][7]

Other assessments such as the Hearing Implant Sound Quality Index (HISQUI19) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) have been introduced in the meantime, but like the NCIQ, they focus on specific hearing abilities rather than capturing a broader view of quality of life.[1][5][9] For example, the HISQUI19 is commonly used to assess perceived sound quality through a hearing device, rather than focusing specifically on quality of life.

Currently, there is no international consensus on which QoL questionnaire is the most suitable to evaluate CI outcomes in clinical settings and for research.[2][3][4][7][8]

A Holistic Health Approach: Measuring Quality of Life in People With Hearing Loss

Illg et al., 2023 introduced the Quality of Life in People with Hearing Loss Questionnaire (HL-QoL). This initial study at the Hannover Medical School demonstrated that the German-language HL-QoL questionnaire is a valid and reliable tool to assess quality of life in people with hearing loss.[7]

In addition, the study shows how each item relates to the internationally accepted multidisciplinary framework specified in the International Classification of Functioning, Disability, and Health (ICF) model created by the WHO.[10]

The HL-QoL’s 21 items cover the following domains:

Mental functions
Voice and speech functions
Learning and applying knowledge
General tasks and demands
Communication
Mobility
Interpersonal interactions and relationships
Major life areas
Community, social, and civic life
Attitudes

More recently, Felder et al., 2025 confirmed the validity of an English translation of the HL-QoL as a tool to assess how hearing loss and its treatment can affect an individual’s quality of life.[4] In addition, the study’s results demonstrated the HL-QoL questionnaire’s appropriateness for use with CI recipients in terms of item (question) difficulty along with showing good test reliability.

Tools to Measure Hearing-Related Quality of Life at Your Clinic

“In contrast to longer questionnaires (e.g. the NCIQ), it is easy to complete and administer while still validly capturing HL-related QoL.”

Felder et al., 2025

We know that a patient’s audiogram never tells the whole story. That is why the new HL-QoL questionnaire is here to provide researchers and clinicians with a more holistic way to evaluate hearing outcomes. It may be used with your patients with hearing loss, no matter what type of hearing devices they use, and in multiple ways, such as:

Assisting with counseling and expectation management around receiving and using a hearing device, such as a cochlear implant
Monitoring, quantifying, and documenting patient progress and/or providing hearing outcome evaluations at important milestones (like quantifying user-reported QoL at key milestones, such as prior to implantation or device provision, after device activation, and at regular intervals of device usage)
Identifying needs for current and future rehabilitation
Providing researchers with a holistic hearing outcome to measure quality of life and assess the subjective effectiveness of hearing devices that improve QoL.

Currently, the questionnaire exists in English and German, and the English questionnaire also exists in digital form so that it can easily be filled in by patients and sent back electronically.

By following this link to our rehabilitation download center, you can access all our presently available materials related to the “Quality of Life in People with Hearing Loss Questionnaire” free of charge:

Download the Quality of Life in People with Hearing Loss Questionnaire

Simply select your preferred language after clicking the link. Translations will be added to this link in the future as soon as they are available.

Thank you to Prof. Angelika Illg, Head of the Therapeutical Cochlear Implant Department at the Hannover Medical School in Hannover, Germany and Jenna Felder, Advanced Research Audiologist from the North American Research Laboratory, MED-EL US in Durham, North Carolina, USA for their contributions to this article.

References

^[1]
Amann, E., & Anderson, I. (2014). Development and validation of a questionnaire for hearing implant users to self-assess their auditory abilities in everyday communication situations: the Hearing Implant Sound Quality Index (HISQUI19). Acta Oto-Laryngologica, 134(9), 915–923. https://doi.org/10.3109/00016489.2014.909604
^[2]
Andries, E., Gilles, A., Topsakal, V., Vanderveken, O., Heyning, P. V. de, Rompaey, V. V., & Mertens, G. (2022). The impact of cochlear implantation on health-related quality of life in older adults, measured with the Health Utilities Index Mark 2 and Mark 3. European Archives of Oto-Rhino-Laryngology, 279(2), 739–750. https://doi.org/10.1007/s00405-021-06727-3
^[3]
Andries, E., Gilles, A., Topsakal, V., Vanderveken, O. M., Heyning, P. V. de, Rompaey, V. V., & Mertens, G. (2021). Systematic Review of Quality of Life Assessments after Cochlear Implantation in Older Adults. Audiology and Neurotology, 26(2), 61–75. https://doi.org/10.1159/000508433
^[4]
Felder, J., Koinig, K. A., Anderson, I., Illg, A., & Billinger-Finke, M. (2025). Validation and psychometric properties of the quality of life in people with hearing loss questionnaire (HL-QoL) in English. Acta Oto-Laryngologica, 145(8), 687–694. https://doi.org/10.1080/00016489.2025.2504636
^[5]
Gatehouse, S., & Noble, W. (2004). The Speech, Spatial and Qualities of Hearing Scale (SSQ). International Journal of Audiology, 43(2), 85–99. https://doi.org/10.1080/14992020400050014
^[6]
Hinderink, J. B., Krabbe, P. F. M., & Broek, P. V. D. (2000). Development and application of a health-related quality-of-life instrument for adults with cochlear implants: The Nijmegen Cochlear Implant Questionnaire. Otolaryngology- Head and Neck Surgery, 123(6), 756–765. https://doi.org/10.1067/mhn.2000.108203
^[7]
Illg, A., Amann, E., Koinig, K. A., Anderson, I., Lenarz, T., & Billinger-Finke, M. (2023). A holistic perspective on hearing loss: first quality-of-life questionnaire (HL-QOL) for people with hearing loss based on the international classification of functioning, disability, and health. Frontiers in Audiology and Otology, 1, 1207220. https://doi.org/10.3389/fauot.2023.1207220
^[8]
Lassaletta, L., Calvino, M., Sanchez-Cuadrado, I., Skarzynski, P. H., Cywka, K. B., Czajka, N., Kutyba, J., Tavora-Vieira, D., Heyning, P. van de, Mertens, G., Staecker, H., Humphrey, B., Zernotti, Mario, Zernotti, Maximo, Magele, A., Ploder, M., & Zabeu, J. S. (2022). Using Generic and Disease-Specific Measures to Assess Quality of Life before and after 12 Months of Hearing Implant Use: A Prospective, Longitudinal, Multicenter, Observational Clinical Study. International Journal of Environmental Research and Public Health, 19(5), 2503. https://doi.org/10.3390/ijerph19052503
^[9]
Noble, W., Jensen, N. S., Naylor, G., Bhullar, N., & Akeroyd, M. A. (2013). A short form of the Speech, Spatial and Qualities of Hearing scale suitable for clinical use: The SSQ12. International Journal of Audiology, 52(6), 409–412. https://doi.org/10.3109/14992027.2013.781278
^[10]
World Health Organization. (2026). International Classification of Functioning, Disability and Health (ICF). Retrieved March 4, 2026, from https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

A woman with short, straight brown hair, wearing a dark grey top with a subtle seam detail near the neckline, standing in front of a softly blurred background of cool blue and white tones in an indoor, well‑lit professional setting.

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Mareike Billinger-Finke

Mareike Billinger-Finke, a psychologist with a doctorate in biomedicine, works as a Senior Clinical Research Manager at MED-EL. She has over a decade of experience in hearing-related research and clinical studies. Her work focuses on the intersection of auditory health, cochlear implantation, and patient-reported outcomes. As an expert in the psychosocial aspects of hearing health, particularly health-related Quality of Life, she has contributed to the development of tools that assess patient satisfaction and well-being in the context of hearing loss and hearing implants.

Deepthi Mahadevappa, PhD

Deepthi Mahadevappa, PhD, is a speech language pathologist currently working as a rehabilitation manager at MED-EL headquarters in Innsbruck, Austria. Deepthi has many years of experience working in the field of hearing loss in clinical and educational settings. At present, she contributes to the development of digital rehabilitation tools and supports rehabilitation professionals globally.

Nathan Schackow, MA

Nathan is part of the MED-EL Professionals Blog editorial team. With a background as an English lecturer, Nathan has specialized in writing about innovations in hearing technology and care since 2020. His passion lies in translating complex science into clear, accessible communication that helps inform, inspire, and improve lives.