American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness

Objective There is increasing interest in providing cochlear implants (CIs) in single-sided deafness (SSD) or asymmetric hearing loss (AHL). CI clinics have experienced a range of outcomes when seeking insurance coverage for patients. The study explored the extent to which CI clinics were able to secure insurance coverage and whether there were differences in successfully gaining such coverage. Study Design A SurveyMonkey questionnaire was used to collect data from US CI clinicians. Respondents were from all regions of the United States and represented a diversity of clinic types including hospitals, university-based clinics, private clinics, and schools. Data were collected during August–October 2021 from 105 respondents regarding their clinic's experience in gaining health insurance coverage for pediatric and adult patients who had SSD or AHL. Strategies that had been used for gaining coverage after an initial denial were explored. Interviews were conducted with some respondents to gain additional insights beyond the survey. Results There was a substantial increase in the number of SSD operations conducted after 2019, the year when the Food and Drug Administration (FDA) manufacturer criteria expanded to include CI in SSD and AHL. Respondents were grouped into four categories based on volume of SSD operations before 2019 (≤10, 11–29, 30–49, and ≥50). The number of SSD operations after 2019 went up in all categories except for the 10 or less category, which declined by 43%. A minority of respondents indicated that they were able to obtain SSD insurance coverage infrequently (5%) or almost never (8%). Peer-to-peer review was the most successful approach to overturning an initial denial. Many clinics note that they are nearly always declined for SSD coverage on the first submission and must appeal. Conclusions There is variability in CI coverage for SSD and AHL. Some health insurance coverage is available for patients of all ages, although some clinics note more difficulty gaining coverage for children younger than 5 years because of the FDA criteria. Clinicians are most successful at gaining coverage after an initial denial with peer-to-peer review, although the process is time-consuming and delays surgery. Efforts to expand access to CIs in SSD for children and adults who may benefit might best be addressed by reflecting on what was done to expand insurance coverage in bilateral deafness—a process that depended on relevant clinical research; research presented to the FDA for guidelines change; information sharing with the general public and constituencies in the hearing loss field including professionals, parent, and consumer organizations; and ongoing advocacy for change with insurers. To date, outcomes research in young children with CI in SSD is limited. Until such research is conducted and published, insurers will continue to argue that other rehabilitative options are approved and available.

Section: Resultsmentioning

confidence: 99%

Health Insurance Coverage of Cochlear Implantation in Single-Sided Deafness and Asymmetric Hearing Loss

Sorkin,

Adunka,

Westin

2023

“…Also, we were unable to control for factors such as duration of deafness, etiology of deafness, or age at implantation because individual patient data were not available across all studies and categories. Although these factors have demonstrated some prognostic value in the traditional CI recipient population with bilateral severe-to-profound SNHL, the impact of these factors in the SSD population remains poorly understood (64). In addition, the test methodologies varied across studies, such as differences in the number of loudspeakers and type of stimuli for sound source localization.…”

Section: Discussionmentioning

confidence: 99%

Cochlear Implantation Outcomes in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis

Daher¹,

Kocharyan²,

Dillon³

et al. 2023

Self Cite

ObjectiveTo assess spatial hearing, tinnitus, and quality-of-life outcomes in adults with single-sided deafness (SSD) who underwent cochlear implantation.Databases ReviewedPubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched from January 2008 to September 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.MethodsStudies reporting spatial hearing, tinnitus, and quality-of-life outcomes in adult cochlear implant (CI) recipients (≥18 yr old) with SSD were evaluated. Study characteristics, demographic data, spatial hearing (speech recognition in noise, sound source localization), tinnitus (severity, loudness), and quality-of-life outcomes were collected.ResultsFrom an initial search of 1,147 articles, 36 studies that evaluated CI use in 796 unique adults with SSD (51.3 ± 12.4 yr of age at time of implantation) were included. The mean duration of deafness was 6.2 ± 9.6 years. There was evidence of improvement for speech recognition in noise using different target-to-masker spatial configurations, with the largest benefit observed for target-to-masker configurations assessing head shadow (mean, 1.87–6.2 dB signal-to-noise ratio). Sound source localization, quantified as root-mean-squared error, improved with CI use (mean difference [MD], −25.3 degrees; 95% confidence interval [95% CI], −35.9 to −14.6 degrees; p < 0.001). Also, CI users reported a significant reduction in tinnitus severity as measured with the Tinnitus Handicap Inventory (MD, −29.97; 95% CI, −43.9 to −16.1; p < 0.001) and an improvement in spatial hearing abilities as measured with the Spatial, Speech, and Qualities of Hearing questionnaire (MD, 2.3; 95% CI, 1.7 to 2.8; p < 0.001).ConclusionsCochlear implantation and CI use consistently offer improvements in speech recognition in noise, sound source localization, tinnitus, and perceived quality of life in adults with SSD.

“…Recently, frailty index has been used as an indirect marker of overall health before surgery and did not affect audiologic outcomes after CI (15). Other areas where cochlear implant indications are expanding or evolving include patients with single-sided deafness, cochlear nerve aplasia, residual hearing, vestibular schwannomas, and Menière's disease (16)(17)(18). The number of people within the United States 65 years and older is expected to double by 2060 to more than 98 million (19).…”

Section: Discussionmentioning

confidence: 99%

National Trends in Cochlear Implantation Across the Department of the Defense: A Case for Inclusion as a General Otolaryngology Core Competency

Adams,

Marinelli,

DeJong

et al. 2023

Objective With ongoing national expansions in cochlear implantation (CI) candidacy criteria, more patients qualify for CI today than ever before. Among US veterans and military service members, the prevalence of qualifying degrees of hearing loss secondary to occupational noise exposure exceeds the general population. The primary aim of the current work was to evaluate CI trends across the military health system. Study Design Database review. Setting Military and civilian practices. Patients Department of Defense (DoD) beneficiaries who underwent CI. Main Outcome Measures CI rates between 2010 and 2019. Results A total of 3,573 cochlear implant operations were performed among DoD beneficiaries from 2010 to 2019. A majority of patients (55%) were older than 64 years, with the next most commonly implanted age group being 0 to 4 years of age (14%). From 2010 to 2019, annual CI increased at a rate of 7.9% per year for all implantation over the study period (r = 0.97, p < 0.0001); there was a statistically significant difference of this rate compared with tympanoplasty, which was used as a reference procedure (rate, −1.9%; p = 0.03). This trend was similar for beneficiaries implanted both in military (11.9% per year, r = 0.77, p = 0.009) and civilian facilities (7.7% per year, r = 0.96, p < 0.0001); there was no statistically significant difference between the annual growth rates of these groups (p = 0.68). Conclusions Although the number of devices implanted is rapidly increasing among DoD beneficiaries, reported national utilization rates remain low. This disparity likely exists in the general public, considering the aging demographic in the West and continual expansions in US Federal Drug Administration labeling. These data suggest that widespread expansion of the procedure to general otolaryngology practices will be required to meet current and future demands for CI. For this reason, CI should be considered for “key indicator” designation among residency training programs.