Auditory Outcomes Following Cochlear Implantation in Children with Unilateral Hearing Loss.

OBJECTIVE: Unilateral hearing loss (UHL) in children is associated with speech and language delays. Cochlear implantation (CI) is currently the only rehabilitative option that restores binaural hearing. This study aims to describe auditory outcomes in children who underwent CI for UHL and to determine the association between duration of hearing loss and auditory outcomes. STUDY DESIGN: Retrospective case series. SETTING: Three tertiary-level, academic institutions. PATIENTS: Children <18 years with UHL who underwent CI between 2018 and 2021. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Speech perception and Speech, Spatial and Qualities of Hearing Scale (SSQ) were assessed postimplantation. Scores >50% on speech perception and SSQ scores >8 points were considered satisfactory. Associations between duration of UHL and implantation age and outcomes were assessed using Spearman's rank correlation. RESULTS: Of the 38 children included, mean age at CI was 7.9 ± 3.2 years and mean UHL duration was 5.0 ± 2.8 years. Mean datalogging was 8.1 ± 3.1 hours/day. Mean auditory testing scores were SSQ, 7.9 ± 1.2; BABY BIO, 68.1 ± 30.2%; CNC, 38.4 ± 28.4%; WIPI, 52.5 ± 23.1%. Scores >50% on CNC testing were achieved by 40% of patients. SSQ scores >8 points were reported by 78% (7/9) of patients. There were no significant correlations between UHL duration and auditory outcomes. CONCLUSION: Overall, children with UHL who undergo CI can achieve satisfactory speech perception scores and SSQ scores. There were no associations between duration of hearing loss and age at implantation with auditory outcomes. Multiple variables may impact auditory outcomes, including motivation, family support, access to technology, and consistent isolated auditory training postactivation and should be taken into consideration in addition to age at implantation and duration of UHL in determination of CI candidacy.

Functional Assessment of Hearing Aid Benefit: Incorporating Verification and Aided Speech Recognition Testing into Routine Practice.

Potential cochlear implant (CI) candidates arrive to the clinic with a variety of hearing loss configurations, hearing aid history, and aided capabilities. CI candidacy is primarily determined based on aided speech recognition capability, which relies on benefit derived from use of hearing aids. Therefore, contemporary evaluation for CI candidacy should incorporate a battery of testing to determine abilities and limitations and must be predicated on appropriate verification of the hearing aid fitting. However, recent reports, including a retrospective chart review of patients presenting to Cleveland Clinic for CI evaluation, suggest that a significant subset of patients may be using inappropriately fit or programmed amplification. Thus, a combination of simulated real-ear measurements and aided speech recognition testing is essential for fully assessing the effect of amplification and ultimately determination of CI candidacy. Furthermore, waiting to incorporate these tools until CI candidacy is suspected may delay timely identification of problems or need to change technology. Utilization of evidence-based decision drivers ultimately leads clinicians to timely patient-specific interventions which may include surgical intervention or other amplification options. As audiology moves into a healthcare era in which payers consider the benefit of our services to overall health and well-being, demonstrating timely, optimal outcomes using thorough, multifactorial evaluation is essential.

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.