Translation and validation of the extended version of the effort assessment scale for adults with cochlear implant in Turkish language

Abstract

Objectives Although assessing listening effort is clinically essential, no validated Turkish self-report measure currently exists. This study aimed to translate and culturally adapt the Extended version of the Effort Assessment Scale (EEAS) into Turkish and to evaluate the validity and reliability of the Turkish EEAS (T-EEAS) in adults with typical hearing (TH) and cochlear implant (CI) users. Methods A standardized cross-cultural adaptation protocol was followed. Psychometric properties were evaluated in 567 adults (463 TH and 104 CI users). Construct validity was examined using confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha, test-retest correlation, intraclass correlation coefficient (ICC), and Bland–Altman agreement analysis. Discriminant validity was evaluated by comparing T-EEAS scores between groups. Results Confirmatory factor analysis supported a two-factor structure with good model fit. The T-EEAS showed high internal consistency (Cronbach’s alpha = 0.938) and excellent test-retest reliability (Spearman’s r = 0.867; ICC = 0.877). CI users reported higher listening effort than the TH group (P < 0.001), with a large effect size (Cliff’s δ = 0.838). Discussion The T-EEAS captures subjective listening effort in Turkish-speaking populations. The two-factor structure distinguishes effort in quiet versus noise, which may support outcome monitoring in audiological rehabilitation. The higher scores observed in CI users support the discriminant validity of the scale. Conclusions The T-EEAS is a valid and reliable measure of subjective listening effort in Turkish-speaking adults and can distinguish between TH adults and CI users, supporting its use in clinical and research settings.