University of Miami team investigates why candidates for cochlear implants rarely get them

December 12, 2019

Many hearing loss patients are cochlear implant candidates, but few use this technology that could improve their hearing and quality of life.

University of Miami and University of Michigan researchers looked into why. Their results were published Dec. 12 in JAMA Otolaryngology-Head and Neck Surgery.

Researchers surveyed U.S. audiologists from academic centers, hospitals and large cochlear implant centers, asking how they preoperatively assess adults for cochlear implant candidacy. Based on the 92 completed surveys analyzed for the study, the findings were "eye opening," according to the paper's lead author, Sandra Prentiss, Ph.D., CCC-A, assistant professor of otolaryngology at the University of Miami Miller School of Medicine.

"Currently, cochlear implant candidacy testing protocols are not streamlined. The survey identified wide variability in how clinics and providers are determining candidacy for patients who may benefit from the technology," Dr. Prentiss said. "The problem is that if there is too much variance, potential candidates will not have the same access to this good treatment option."

Cochlear implants are a greatly under-utilized treatment for hearing loss. Dr. Prentiss said fewer than 9% of people who are candidates for cochlear implants use this technology. Part of the reason appears to be that the criteria for candidacy have changed in recent years and many providers do not know about the changes or have not implemented them in practice.

"Fifteen years ago, candidacy was pretty straightforward in that only people with severe-to-profound hearing loss were candidates," Dr. Prentiss said.

Advances in surgical technique and electrode design have improved outcomes among cochlear implant patients. As a result, the FDA has expanded the criteria for cochlear implants to include people with lesser degrees of hearing loss. This includes elderly people with age-related hearing loss who have not benefited from hearing aids, according to Dr. Prentiss.

"We found that some audiologists are still using old testing methods which will not capture those people who have better than severe-to-profound hearing loss and could potentially benefit from cochlear implants," she said. "This lack of knowledge of new criteria likely plays a large role in the under-utilization of this technology."

Another potential hurdle is there are no clear guidelines for how to best test patients. The testing should go well beyond what a person's hearing looks like on paper, and should include assessing quality-of-life factors, the patient's access and willingness to participate in rehabilitation exercises, and a patient's cognitive state, according to Dr. Prentiss.

"We've seen that age alone is no longer a contraindication for cochlear implants. We have to be able to capture these people that have progressive hearing loss and are not doing well with hearing aids. Those patients may not have access to the technology because a lot of providers don't realize that you can have quite a bit of hearing and still benefit from a cochlear implant," she said.

The message to physicians who encounter patients complaining of hearing loss is to refer them for a cochlear implant evaluation, according to Dr. Prentiss.

"If you have a patient who is really struggling and his or her quality of life is going down because of hearing loss, it's never a bad thing to refer that patient to get a cochlear implant evaluation. At least if they are referred, we can get an idea of how they are performing in noise and their overall quality of life. If they don't meet candidacy criteria then maybe we have a baseline and can look for other options that might help them."

Other solutions to the problem include developing clear guidelines for cochlear implant evaluations, as well as educating providers, including audiologists, about current best practices for determining if patients are candidates.

"I'm writing a paper with the support of the American Cochlear Implant Alliance, the largest national organization for cochlear implants, in an effort to inform hearing health care professionals what cochlear implant candidacy looks like today and when it may be appropriate to refer for an evaluation," Dr. Prentiss said.

This national survey is a step toward identifying the eye-opening variability in preoperative assessment practices for evaluating and managing adults with hearing loss in the U.S. The ambiguity, according to Dr. Prentiss, highlights the potential risks for health care inequities, including access to care.

University of Miami Miller School of Medicine

Related Hearing Loss Articles from Brightsurf:

Proof-of-concept for a new ultra-low-cost hearing aid for age-related hearing loss
A new ultra-affordable and accessible hearing aid made from open-source electronics could soon be available worldwide, according to a study published September 23, 2020 in the open-access journal PLOS ONE by Soham Sinha from the Georgia Institute of Technology, Georgia, US, and colleagues.

Ultra-low-cost hearing aid could address age-related hearing loss worldwide
Using a device that could be built with a dollar's worth of open-source parts and a 3D-printed case, researchers want to help the hundreds of millions of older people worldwide who can't afford existing hearing aids to address their age-related hearing loss.

Understanding the link between hearing loss and dementia
Scientists have developed a new theory as to how hearing loss may cause dementia and believe that tackling this sensory impairment early may help to prevent the disease.

Study uncovers hair cell loss as underlying cause of age-related hearing loss
In a study of human ear tissues, scientists have demonstrated that age-related hearing loss is mainly caused by damage to hair cells.

Hair cell loss causes age-related hearing loss
Age-related hearing loss has more to do with the death of hair cells than the cellular battery powering them wearing out, according to new research in JNeurosci.

How hearing loss in old age affects the brain
If your hearing deteriorates in old age, the risk of dementia and cognitive decline increases.

Examining associations between hearing loss, balance
About 3,800 adults 40 and older in South Korea participating in a national health survey were included in this analysis that examined associations between hearing loss and a test of their ability to retain balance.

Veterinarians: Dogs, too, can experience hearing loss
Just like humans, dogs are sometimes born with impaired hearing or experience hearing loss as a result of disease, inflammation, aging or exposure to noise.

Victorian child hearing-loss databank to go global
A unique databank that profiles children with hearing loss will help researchers globally understand why some children adapt and thrive, while others struggle.

Hearing loss, dementia risk in population of Taiwan
A population-based study using data from the National Health Insurance Research Database of Taiwan suggests hearing loss is associated with risk of dementia.

Read More: Hearing Loss News and Hearing Loss Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to