English translation and validation of the Zurich chronic middle ear inventory (ZCMEI-21-E) assessing quality of life in chronic otitis media: A prospective international multicentre study

Clin Otolaryngol. 2019 May;44(3):254-262. doi: 10.1111/coa.13275. Epub 2019 Jan 14.


Objectives: To translate and validate the Zurich Chronic Middle Ear Inventory (ZCMEI-21) for the English language in order to provide an English instrument to assess health-related quality of life in chronic otitis media (COM).

Design: Pilot translation study including cognitive debriefings, prospective multicentre cross-sectional psychometric validation study.

Setting: Four tertiary referral centres in three different English-speaking countries (UK, USA and Australia).

Participants: Adult patients suffering from COM.

Main outcome measures: The English translation of the ZCMEI-21 (ZCMEI-21-E) and the five-level version of the EQ-5D questionnaire. The EQ-5D, which constitutes a generic measure of health-related quality of life, consists of a descriptive system score and a visual analogue scale. Statistical outcomes included single-item descriptive statistics, internal consistency (Cronbach's α) as an indicator of reliability, as well as construct validity.

Results: A total of 124 patients suffering from COM were included. The mean age was 50.1 years (SD 16.9 years), and 72 (58.1%) were males. The Cronbach's α of the ZCMEI-21-E was 0.91, suggesting an excellent internal consistency. The Spearman's correlation coefficient of the ZCMEI-21-E total score was 0.55 (P < 0.0001) for convergent construct validity with EQ-5D descriptive system score and 0.57 (P < 0.0001) with the EQ-5D visual analogue scale.

Conclusions: The ZCMEI-21-E is a new validated questionnaire that provides clinicians with a short, comprehensive and reliable instrument to quantify health-related quality of life in patients suffering from COM. The ZCMEI-21-E may be of use in clinical routine as well as in outcome research and monitoring.

Keywords: English; HRQoL; ZCMEI-21; cholesteatoma; chronic otitis media; electronic patient-reported outcome measure; otology; questionnaire; translation.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Chronic Disease
  • Cross-Sectional Studies
  • Female
  • Humans
  • Language*
  • Male
  • Middle Aged
  • Otitis Media / psychology*
  • Prospective Studies
  • Psychometrics / methods*
  • Quality of Life*
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Translations*