Diurnal Cortisol Levels and Subjective Ratings of Effort and Fatigue in Adult Cochlear Implant Users: A Pilot Study.

The sample was very small (16 participants total) and highly selected: all were successful graduate students in audiology with long-standing hearing loss and extensive experience with their devices. This population may have better coping strategies than the general patient population. The study had low statistical power, meaning it could only detect extremely large differences between groups. Cortisol sampling intervals were sparse (only three points per day), which may have missed subtle physiological stress responses. The lecture task was not standardized; participants attended different lectures, and no baseline cortisol was measured before the lecture, preventing analysis of change during the task.

Funded by the National Institute on Deafness and Other Communication Disorders (Grant DC011052). The grant paid for saliva analysis and participant remuneration. No commercial conflicts of interest were declared.

Do not conclude that adults with hearing loss do not experience increased stress or fatigue. This study found no difference in general fatigue or cortisol, but this may be because the participants were a highly successful, resilient subgroup of graduate students, or because generic measures are insensitive to listening-specific burden. The significant increase in subjective listening effort and fatigue suggests the problem exists, even if the physiological marker did not track it in this small pilot.