Using Clinical Audiologic Measures to Determine Cochlear Implant Candidacy

Access to Cochlear Implantation: Trends in Surgeon Volume and Training

OBJECTIVES

Evaluate the training background of surgeons performing high volumes of cochlear implants (CIs) and estimate the ratio of providers trained in otology/neurotology (O&N) to the number of traditional CI candidates and audiologists.

METHODS

A retrospective review of US surgeon registration data from a single CI manufacturer was performed to determine CI volume based on surgeon training. The prevalence of traditional candidates for CIs was estimated from US census population data and compared with the number of O&N providers. The ratio of audiologists to O&N providers was estimated from the Bureau of Labor and Statistics and American Speech-Language-Hearing Association databases.

RESULTS

From 2021 to 2023, a mean of 88% of providers performing ≥25 CIs per year and 90% performing ≥40 per year had training in O&N. All surgeons registering ≥100 implants per year were O&N providers. The mean percentage of O&N providers performing ≥25 CIs per year and ≥ 40 per year was higher than the percentage of General and Pediatric Otolaryngology providers performing the same volume: mean difference = 76%, p < 0.001 and mean difference = 79%, p < 0.001, respectively. The mean estimated prevalence of traditional CI candidates per O&N provider is 3,354 with an estimated mean of 32 audiologists (3.5 trained in CIs) per O&N provider.

CONCLUSION

88% of high-volume CI surgeons have fellowship training in O&N. To meet the current state of CI underutilization and anticipated growing population of CI candidates, we propose increasing the surgical capacity of O&N providers and the number of surgeons proficient in CIs.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:2146-2153, 2025.

Comparing remote programming of cochlear implants using two methods: portable laptop and remote hosted site

OBJECTIVES

Compare two remote programming methods as a clinical service for user satisfaction, ease of use, preparation time and accessibility.

METHOD

Method 1 (Portable Laptop): A 'Programming Kit' including laptop was shipped to cochlear implant users' homes (N = 20). The audiologist at the implant center used remote desktop control of this laptop to adjust subjects' speech processors. Method 2 (Remote Hosted Site): Eight distant clinics were recruited as host sites to house cochlear implant programming hardware and software so that CI users (N = 19) could attend their facility. The audiologist at the implant center used remote desktop control of the host sites' computers to adjust the subjects' CI speech processors. All parties were asked to fill out a questionnaire following their remote session.

RESULTS

Remote hosted site method was rated higher for ease of use by the Remote Experts (12/15, 80%), compared to portable laptop method (11/19, 57.9%) and is more accessible to CI users of all levels of computer abilities while requiring less preparation time per session.

CONCLUSION

Remote hosted site method is an easier, more efficient method of remote programming as a clinical service delivery method compared to the Portable Laptop.

Diagnostic value of preoperative measures in selecting post-lingually deafened candidates for cochlear implantation - a different approach

OBJECTIVES

We examined which preoperative diagnostic measure is most suited to serve as a selection criterion to determine adult cochlear implantation (CI) candidacy.

DESIGN

Preoperative diagnostic measures included pure tone audiometry (PTA; 0.5, 1, 2, 4 kHz), speech perception tests (SPT) unaided with headphones and with best-aided hearing aids (in quiet and in noise). Gain in speech perception was used as outcome measure. Performance of preoperative measures was analysed using the area under the curve (AUC) of receiver operating characteristic (ROC) curves.

STUDY SAMPLE

This retrospective longitudinal cohort study included 552 post-lingually deafened adults with CI in a tertiary referral centre in the Netherlands.

RESULTS

Best-aided SPT in quiet was the most accurate in defining which CI candidates improved their speech perception in quiet postoperatively. For an improvement in speech perception in noise, the best-aided SPT in noise was the most accurate in defining which adult would benefit from CI. PTA measures performed lower compared to the SPT measures.

CONCLUSIONS

SPT is better than PTA for selecting CI candidates who will benefit in terms of speech perception. Best-aided SPT in noise was the most accurate for indicating an improvement of speech perception in noise but was only evaluated in high performers with residual hearing. These insights will assist in formulating more effective selection criteria for CI.