Implementation Strategy for Highly-Coordinated Cochlear Implant Care With Remote Programming: The Complete Cochlear Implant Care Model

Remote self-testing for adult cochlear implant users: the effect of wireless streaming on speech recognition in noise

OBJECTIVES

Wireless sound transfer methods for cochlear implant sound processors have become popular for remote self-assessed hearing tests. The aim of this study was to determine (1) spectral differences in stimuli between different wireless sound transfer options and (2) the effect on outcomes of speech recognition tests in noise.

DESIGN

In study 1, the frequency response of different streaming options (Phonak Roger Select, Cochlear Mini Mic 2+, telecoil and Bluetooth connection) was measured by connecting headphones to CI sound processors. Study 2 followed a repeated measures design in which digits-in-noise (DIN) tests were performed using wireless streaming to sound processors from Cochlear, Advanced Bionics, and MED-EL.

STUDY SAMPLE

20 normal hearing participants.

RESULTS

Differences in frequency response between loudspeaker and wireless streaming conditions were minimal. We did not find significant difference in DIN outcome (F4,194 = 1.062, p = 0.376) between the wireless transfer options with the Cochlear Nucleus 7 processor. No significant difference in DIN outcomes was found between Bluetooth streaming and the loudspeaker condition for all of the three tested brands. The mean standard error of measurement was 0.72 dB.

CONCLUSIONS

No significant differences in DIN test outcomes between wireless sound transfer and the reference method were found.

Breaking Sound Barriers: Exploring Tele-Audiology's Impact on Hearing Healthcare

Hearing impairment is a global issue, affecting billions of people; however, there is a gap between the population affected by hearing loss and those able to access hearing healthcare. Tele-audiology, the application of telemedicine in audiology, serves as a new form of technology which aims to provide synchronous or asynchronous hearing healthcare. In this article, we reviewed some recent studies of tele-audiology-related topics to have a glimpse of the current development, associated challenges, and future advancement. Through the utilization of tele-audiology, patients can conveniently access hearing healthcare, and thus save travel costs and time. Recent studies indicate that remote hearing screening and intervention are non-inferior to the performance of traditional clinical pathways. However, despite its potential benefits, the implementation of tele-audiology faces numerous challenges, and audiologists have varying attitudes on this technology. Overcoming obstacles such as high infrastructure costs, limited reimbursement, and the lack of quality standards calls for concerted efforts to develop effective strategies. Ethical concerns, reimbursement, and patient privacy are all crucial aspects requiring in-depth discussion. Enhancing the education and training of students and healthcare workers, along with providing relevant resources, will contribute to a more efficient, systematic hearing healthcare. Future research will aim to develop integrated models with evidence-based protocols and incorporating AI to enhance the affordability and accessibility of hearing healthcare.

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

BACKGROUND

Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral.

METHODS AND FINDINGS

A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups.

CONCLUSIONS

The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.

Audiologists' attitudes and practice toward referring for psychosocial intervention with cochlear implant patients

Background

Hearing loss is associated with a range of poor psychosocial outcomes. Cochlear implants (CI) are an available treatment option for significant hearing loss and have been linked to improved quality of life in patients. Evidence suggests that audiologists lack the skills to appropriately detect, address, and refer for psychosocial needs among patients with hearing loss. The objective of this study is to examine the attitudes and practice patterns related to psychosocial care among audiologists who work with CI users.

Methods

A cross-sectional survey was administered to clinical audiologists who work with CI recipients in the United States. The survey evaluated participants' attitudes toward psychosocial services and factors that contribute to their abilities to address the psychosocial needs of their patients. Additionally, participants were surveyed about their practice patterns including the use of psychosocial screeners, clinical protocols regarding psychosocial care, and referral patterns for coordinated psychosocial services. Descriptive statistics were used to summarize survey responses.

Results

Sixty-eight audiologists completed the survey. Of these audiologists, a majority (73.6%) held the attitude that most or all CI patients would benefit from psychosocial intervention. Despite clinicians' recognition of psychosocial needs in this population, over 90% of participants reported never screening for psychosocial symptoms. Additionally, a majority of respondents indicated that they seldom refer their patients for psychosocial services, with referrals occurring less than half the time (58%) or never (27%). Additionally, few audiologists reported utilizing protocols or resources for guiding psychosocial practices. Audiologists indicated that the primary factors that influence their psychosocial practices include time available to spend with the patient and their comfort level in counseling.

Conclusion

Audiologists working with CI patients recognize the potential benefit of psychosocial intervention in this population. Nevertheless, audiologists encounter barriers in clinical practice which limit their ability to identify and address the psychosocial needs of their patients. Strategies designed to enhance audiologists' capacity to recognize the psychosocial needs of CI users, in addition to improved interprofessional practice on CI teams, implies significant opportunities to improve the provision of patient-centered hearing care.

Incidence of Cochlear Implantation Among Adult Candidates in the United States

OBJECTIVES

To investigate the associations of age and year of cochlear implantation (CI) with CI incidence among adults 20 years and older residing in the US.

STUDY DESIGN

Deidentified cochlear implant data were acquired from prospective patient registries from two cochlear implant manufacturers (Cochlear Americas and Advanced Bionics), which supply an estimated 85% of cochlear implants in the US. Population estimates for severe-to-profound sensorineural hearing loss by age group were extracted from Census and National Health and Nutrition Examination Survey data.

SETTING

US CI centers.

PATIENTS

Adults 20 years and older who underwent CI.

INTERVENTIONS

CI.

MAIN OUTCOME MEASURES

CI incidence.

RESULTS

The study cohort included 30,066 adults 20 years and older who underwent CI from 2015 to 2019. When combining actual and estimated data from all three manufacturers, the annual number of cochlear implants increased 5,406 in 2015 to 8,509 in 2019. Overall, the incidence of CI among adult traditional (bilateral severe-to-profound hearing loss) CI candidates increased from 244 per 100,000 person-years in 2015 to 350 in 2019 ( p < 0.001). Although the elderly (80 years and older) population had the lowest incidence of CI, this cohort experienced the largest growth from an incidence of 105 per 100,000 person-years to 202 during the study period.

CONCLUSIONS

Despite growing incidence among those with qualifying hearing loss, cochlear implants remain widely underutilized. Elderly adults continue to exhibit the lowest relative cochlear implant utilization rates; however, trends over the last half-decade suggest a shift has occurred, resulting in improved access among this underserved subset.

Hearing health care access for adult cochlear implant candidates and recipients: Travel time and socioeconomic status

Objectives

Access to cochlear implantation may be negatively influenced by extended travel time to a cochlear implant (CI) center or lower socioeconomic status (SES) for the individual. There is a critical need to understand the influence of these variables on patient appointment attendance for candidacy evaluations, and CI recipients' adherence to post-activation follow-up recommendations that support optimal outcomes.

Methods

A retrospective chart review of adult patients referred to a CI center in North Carolina for initial cochlear implantation candidacy evaluation between April 2017 and July 2019 was conducted. Demographic and audiologic data were collected for each patient. Travel time was determined using geocoding. SES was proxied using ZCTA-level Social Deprivation Index (SDI) information. Independent samples t tests compared variables between those who did and did not attend the candidacy evaluation. Pearson correlations assessed the association of these variables and the duration of time between initial CI activation and return for first follow-up visit.

Results

Three hundred and ninety patients met the inclusion criteria. There was a statistically significant difference between SDI of those who attended their candidacy evaluation versus those who did not. Age at referral or travel time did not show statistical significance between these two groups. There was no significant correlation with age at referral, travel time, or SDI with the duration of time (days) between initial activation and the 1-month follow-up.

Conclusions

Our findings suggest that SES may influence a patient's ability to attend a cochlear implantation candidacy evaluation appointment and may further impact the decision to pursue cochlear implantation.Level of evidence: 4 - Case Series.