Audiology Practices in the Preoperative Evaluation and Management of Adult Cochlear Implant Candidates

Abstract

IMPORTANCE Currently, no clear guidelines exist regarding clinical testing methods for identifying adult cochlear implant (CI) candidates. Indications provided by the US Food and Drug Administration, Medicare, and private insurers are ambiguous concerning test materials and the level and mode of test presentation. This could lead to wide variability in clinical assessment and, potentially, unequal access to CIs for individuals with clinically significant hearing loss. OBJECTIVE To examine the preoperative testing methods used by audiologists in evaluating adult CI candidates across the United States. DESIGN, SETTING, AND PARTICIPANTS A survey assessing audiology practice patterns was created using a Research Electronic Data Capture system hosted at the University of Miami. A link to a survey (65 questions in multiple-choice or rank-order format was distributed electronically along with a request for completion to members of the American Cochlear Implant Alliance and to the Institute for Cochlear Implant Training forum. Responses were collected from January 17 to June 4, 2018. Participation was limited to audiologists who evaluate adult CI candidates, and respondents who do not provide adult CI care were excluded. Collected demographic information included work setting, years of experience, and highest level of education attained. MAIN OUTCOMES AND MEASURES Percentages, medians, and interquartile ranges were from aggregated responses concerning hearing aid verification methods; testing methods, materials, and practices; nonauditory factors that might affect CI candidacy; audiology practice patterns; and expanded indications for CIs. RESULTS Anonymized surveys were returned by 99 respondents; because surveys were available electronically, the number of audiologists who viewed the survey but did not respond was not available. Seven respondents identified themselves as pediatric specialists and were excluded, resulting in a total of 92 surveys available for analysis (denominators vary because respondents could complete the survey without answering all questions). Seventy percent of respondents (51 of 72) were doctors of audiology, and nearly 50% (33 of 74) were employed at universities and academic centers performing more than 50 CIs per year. When assessing adult candidacy for implant, most respondents reported using test materials from the Minimum Speech Test Battery: 96% (51 of 53), using AzBio sentences in quiet; 89% (47 of 53), AzBio sentences in noise; and 100% (53 of 53), the consonant-vowel nucleus-consonant, monosyllabic words test. However, these tests were applied inconsistently, with 39 of 53 respondents (74%) reporting use of a sound pressure level scale and the other 14 (26%) a hearing level scale at various decibel levels, and with some using a single signal-to-noise ratio and others using multiple ratios for sound-in-noise tests. Respondents' definitions of the best aided listening condition for assessing implant candidates also varied widely. Among the nonauditory factors ranked most important for as...

Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery

“…Despite the substantial influence on CI candidacy qualification, speech perception testing in noise is not standardized across the United States, and practice variability includes extremes of the range from no testing in noise to +5 dB signal-to-noise ratio utilized to qualify patients for CIs. 37 50 It follows that patients with residual hearing who undergo CI evaluation without noise are less likely to qualify for CI compared with those who complete testing in noise. 51 To compound the obstacles associated with CI candidacy testing, patient interviews have suggested that the testing battery does not represent real-world hearing difficulties and may have an impact on whether individuals decide to proceed with surgery.…”

Comparing the Speech Perception of Cochlear Implant Users with Three Different Finnish Speech Intelligibility Tests in Noise

“…Clinical guidelines also provide recommendations for a standardized use of the tests [10]. However, a recent survey revealed that the recommended procedures are not always followed in the clinic [33], which can lead to biased results and further complicate their interpretation.…”

“…The variability in CI rehabilitation results is considerable [1,3,37], and the concept of CI user reference data is complicated, as it is inevitable that the average performance of a large CI patient population may be an unrealistic goal for some CI users and an underachievement for others. Nevertheless, the need for CI user reference data that is collected from a large, unselected patient population under standardized, well-defined testing conditions is recognized in multiple recent publications [12,33,38].…”

Determining Cochlear Implant Candidacy in Adults: Limitations, Expansions, and Opportunities for Improvement

“…This protocol change is supported by the report of Prentiss et al, 27 who recently noted that 100% of clinics surveyed indicated they include word tests in their pre-and postoperative test batteries, even though not all indications base candidacy on such a score. Additionally, 89% of respondents use some form of sentence testing in noise to determine CI candidacy.…”