Issues in Cochlear Implant Candidacy

Vickers, Deborah; Kitterick, Pádraig T.; Verschuur, Carl; Leal, Carolina; Jenkinson, Louise; Vickers, Fiona; Graham, John M.

doi:10.1080/14670100.2016.1163104

Cited by 6 publications

(3 citation statements)

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“…The results described above endorse the idea that in countries that hold on to more conservative criteria for CI candidacy, expansion of CI indication is beneficial for long-term benefit [ 2 – 4 , 28 , 29 ]. CI performance has improved and more evidence was found for the positive effect of residual hearing on CI outcome, strengthening the growing need for a shift of CI indication.…”

Section: Discussionsupporting

confidence: 68%

Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Huinck

Mylanus

Snik

2019

Eur Arch Otorhinolaryngol

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Objectives To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation. Methods Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients that fulfilled conservative criteria (mean hearing loss at 0.5, 1 and 2 kHz > 85 dB HL and phoneme scores with hearing aids < 30%), and the remaining group of patients that felt outside this conservative criterion. Speech recognition scores (in quiet) and quality of life (using the NCIQ) of both groups, measured at 1-year post-implantation, were compared. Results The group that felt outside the conservative criterion showed a higher phoneme score at 1-year post-implantation compared to the conservative group, suggesting that relaxed criteria have a positive influence on the speech recognition results with CI. With respect to quality of life, both groups significantly improved 1-year post-implantation. The conservative group showed a higher benefit on the advanced perception domain of the NCIQ. Based on their worse pre-implantation hearing, this was expected. Conclusions The data suggest that relaxation of CI indication positively affects the speech recognition performance of patients with severe hearing loss. Both groups of patients showed a positive effect of CI on the quality of life. This benefit relates to communication skills and the subjective day-to-day functioning in society.

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Section: Discussionsupporting

confidence: 68%

Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Huinck

Mylanus

Snik

2019

Eur Arch Otorhinolaryngol

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“…30 A change to using word scores in adult CI candidacy consideration would also bring the United States closer to the indications used by most other countries. 36 Varadarajan et al 37 provided additional compelling reasons for expansion of current indications, including recent increases in the number of adults with atypical etiologies who receive benefit from CIs, such as those with advanced otosclerosis, posttraumatic SNHL, those undergoing labyrinthectomy, and patients presenting with vestibular schwannomas. They importantly state that expansion of indications could result in improvement in the DETERMINING COCHLEAR IMPLANT CANDIDACY IN ADULTS/ZWOLAN, BASURA underutilization of CIs currently seen in the United States.…”

Section: Calls For Changementioning

confidence: 99%

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

Zwolan

Basura

2021

Semin Hear

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The safety, efficacy, and success of cochlear implants (CIs) are well established and have led to changes in criteria used by clinicians to determine who should receive a CI. Such changes in clinical decision-making have out-paced the slower-occurring changes that have taken place with regulatory bodies' and insurers' indications. We review the historical development of indications for CIs, including those of the U.S. Food and Drug Administration (FDA), Medicare, Medicaid, and private insurers. We report on expansion to include patients with greater residual hearing, such as those who receive Hybrid and EAS devices, and report on recent FDA approvals that place less emphasis on the patient's best-aided condition and greater emphasis on the ear to be treated. This includes expansion of CIs to patients with single-side deafness and asymmetric hearing loss. We review changes in the test materials used to determine candidacy, including transition from sentences in quiet to sentences in noise to the recent use of monosyllabic words and cognitive screening measures. Importantly, we discuss the recent trend to recommend CIs despite a patient not meeting FDA or insurers' indications (a practice known as “off-label”), which serves as attestation that current indications need to be updated.

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“…Firstly, it is a more costly treatment with an adult surgery and follow up. However, CIs have been shown to be highly cost effective with low complication rates and in most developed economies, funding is provided either by a national health programs or employer based or private insurance schemes [33,44]. None the less, lack of funding has the potential to restrict the number of suitable adults who are implanted, particularly in undeveloped economies.…”

Section: Treatment Options and Their Usementioning

confidence: 99%

The Need to Increase Awareness and Access to Cochlear Implantation

D’Haese¹,

Rompaey²,

Bodt³

et al. 2020

Advances in Rehabilitation of Hearing Loss

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Some degree of disabling hearing loss is present in 466 million people worldwide, representing 5% of the world's population and the majority of these are adults over 65 years old. Hearing loss is associated with increased risks of social isolation, depression, dementia, stroke, vision loss, diabetes and mortality. It is in the top five causes of years lived with disability in 2015, 2016 and 2017 for males and top 10 for females. Hearing aids are a suitable treatment for mild to moderate loses but for some they do not provide enough benefit. Cochlear implantation is a proven and effective treatment for bilateral severe to profound hearing loss, yet despite good funding in high income countries, the utilisation of CI is poor (less than 10% of suitable patients), especially in the older adult population who arguably need it most. Prevalence data shows that hearing loss increases with age, but the provision of implants in the over 65 s is even lower, despite there being no clinical barriers to older adults receiving a CI. Survey data shows that awareness activities are needed for both professionals and the general population to improve knowledge of what a CI is and how it can help.

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Issues in Cochlear Implant Candidacy

Cited by 6 publications

References 0 publications

Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

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

The Need to Increase Awareness and Access to Cochlear Implantation

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