Evidence for the Expansion of Adult Cochlear Implant Candidacy

Abstract

Objectives The primary objective of this study was to determine whether a revision and/or expansion of current audiologic cochlear implant candidacy criteria is warranted. Design The study design was a retrospective review of postoperative speech perception performance for 22 adult cochlear implant recipients who demonstrated preoperative Consonant Nucleus Consonant word recognition scores of 30% or higher in the best-aided condition. This criterion was chosen to exceed that specified by the North American clinical trial of the Nucleus Freedom cochlear implant system. Results The mean preoperative best-aided monosyllabic word score for the 22 patients was 41% correct. The degree of postoperative benefit for the best postoperative condition (electric only or bimodal) ranged from 10 to 68 percentage points with a mean benefit of 27 percentage points for the electric-only condition and 40 percentage points for the bimodal condition. Statistical analyses revealed highly significant differences between preoperative-aided, implant-only, and bimodal performance on Consonant Nucleus Consonant monosyllabic word recognition performance. That is, both postoperative scores— electric only and bimodal—were significantly different from one another and from the preoperative best-aided performance. Conclusions The current results suggest that a large-scale reassessment of manufacturer and Medicare preoperative audiologic candidacy criteria for adults is warranted to allow more hearing-impaired individuals to take advantage of the benefits offered by cochlear implantation.

Effectiveness of Frequency-Lowering Hearing Aids and Electric Acoustic Stimulation Cochlear Implant for Treating People with a Severe-To-Profound High-Frequency Hearing Loss

“…Instead of shifting high frequencies to a lower frequency range, as it is done by FL HAs, the EAS implant uses electrical stimulation to convey highfrequency information. This technological advance, along with new electrode designs, improvements in surgical techniques and a reduction of implantation related risks opened the door of cochlear implantation to people with a specific severe-toprofound HFHL [7,8]. Thus, those persons have nowadays access to a few technological alternatives to conventional HAs.…”

Speech perception scores in cochlear implant recipients: An analysis of ceiling effects in the CUNY sentence test (Quiet) in post-lingually deafened cochlear implant recipients

“…Today's post-lingually deafened adult implant recipients, however, demonstrate high levels of speech perception scores-inquiet with current sentence tests such as Hearing in Noise (HINT) sentence test in the first few months post implantation (Gifford et al, 2008, Gifford et al, 2010, Fabry et al, 2009, Lenarz et al, 2012, Helms et al, 2004. Gifford et al (2008) reported that 71% of cochlear-implanted adults scored above 85% on a common test of sentence perception in quiet, of whom 28% reached the maximum possible score.…”

“…This, in turn, has resulted in improved speech perception skills of the recipients (Fabry et al, 2009, Gifford et al, 2008, Lenarz et al, 2012, Ruffin et al, 2007, Gifford et al, 2010. In clinical settings, speech perception outcomes are used to identify the potential candidates for CI surgery and also to evaluate the progress of the CI recipient post implantation (Gifford et al, 2008, Alkaf and Firszt, 2007, Gifford et al, 2010, Dowell et al, 2004, Blamey et al, 1992.…”

Effects of Removing Low-Frequency Electric Information on Speech Perception With Bimodal Hearing

“…Cochlear implantation has led to significant improvements over preimplantation amplification for many individuals, including providing improved open set recognition (Carlson et al, 2015;Firszt, Holden, Reeder, Cowdrey, & King, 2012;Gifford et al, 2010). With these improved outcomes, cochlear implant (CI) candidacy guidelines for various companies have recently expanded to include individuals with HL in the moderate as well as the severe-to-profound HL range.…”

“…C ochlear implantation criteria currently include individuals who have aidable hearing-that is, bilateral severe-to-profound sensorineural hearing loss (HL) across the speech frequencies 250-8000 Hz (Carlson et al, 2015;Gifford, Dorman, Shallop, & Sydlowski, 2010;HemanAckah, Roland, Haynes, & Waltzman, 2012;Sampaio, Araújo, & Oliveira, 2011). Cochlear implantation has led to significant improvements over preimplantation amplification for many individuals, including providing improved open set recognition (Carlson et al, 2015;Firszt, Holden, Reeder, Cowdrey, & King, 2012;Gifford et al, 2010).…”