Optimizing Care Delivery by Applying an Innovative Shared Medical Appointment Model for Determination of Cochlear Implant Candidacy.

OBJECTIVE: To develop and implement an innovative group appointment with the potential to improve access to cochlear implantation (CI) while maintaining patient satisfaction and experience. PATIENTS: Adult patients with advanced sensorineural hearing loss. INTERVENTIONS: Implementation of novel shared medical appointment (SMA) model. MAIN OUTCOME MEASURES: Patient satisfaction with group visit; anecdotal description of provider efficiency and experience. RESULTS: Survey data were collected from 166 adults who participated in a group CI candidacy appointment from September 2017 to February 2020 as part of a quality improvement initiative. Provider time is anecdotally optimized by accommodating more patients in a shorter timeframe while effectively triaging those candidates most likely to meet candidacy criteria for a full CI evaluation. Most importantly, patient feedback has been positive which suggests that patients find value in this novel format. CONCLUSIONS: The current climate of healthcare demands that providers maximize the efficacy and efficiency of patient care. Our large CI program has determined that using an SMA format as an entry point for CI candidacy evaluation offers many benefits. The group appointment improves patient throughput and also provides a positive patient experience. Group visits offer a viable solution for increasing patient access to CI while maintaining quality in a busy academic medical center setting.

Successful cochlear implantation in a case of Vogt-Koyanagi-Harada disease.

OBJECTIVE: To characterize the auditory phenotype of Vogt-Koyanagi-Harada disease (VKH) and highlight the potential for successful cochlear implantation (CI). PATIENTS: Single case report INTERVENTION(S): Therapeutic MAIN OUTCOME MEASURE(S): AzBio Sentences in quiet and noise, CNC Words, BKB-SIN RESULTS: VKH is a systemic autoimmune disorder characterized by granulomatous uveitis accompanied by neurologic and auditory-vestibular symptoms. Development is attributed to an autoimmune response against pigmented cells, with destruction of melanocytes by T lymphocytes directed against an unidentified antigen; accordingly, the disease typically affects races with darkly pigmented skin. VKH presents as blurring of vision and eye inflammation, severe headaches, and meningismis. Auditory symptoms include sensorineural hearing loss (SNHL), tinnitus, and imbalance. SNHL can persist despite immunosuppressant therapy.This report describes successful cochlear implantation in a 26-year-old female patient with VKH who presented with complaints of blurred vision and bilateral sudden SNHL. Oral steroids initially restored hearing, but benefit ceased upon discontinuation of oral steroids and was not restored following a series of intratympanic steroid injections. The patient underwent bilateral CI, which was fast-tracked because of the autoimmune nature of her hearing loss. After implantation, her speech understanding in both quiet and noise far exceeds her pre-implant scores. CONCLUSION: This unique case is the first to report successful CI in VKH. It is important for hearing health professionals to be aware of the signs and symptoms of this disease as patients may present initially with hearing loss, tinnitus, or imbalance, and may benefit from CI in cases of persistent, steroid-unresponsive, severe-to-profound SNHL.