RESUMO
OBJECTIVE: To use a standardised reporting tool to identify potential eligible candidates for cochlear implant (CI) referral and quantify the proportion of adults who had a CI referral discussion after presenting with an audiogram within United Kingdom (UK) audiometric criteria. DESIGN: Retrospective multicentre 6-month audit of Audiology clinic databases. STUDY SAMPLE: A total of 810 adults from five geographically diverse UK Audiology sites. RESULTS: Data were collected in late 2019 after UK CI audiometric candidacy criteria changed; one site collected only 3 months of data. The proportion of potential eligible adults (based only on audiometry) considered for CI referral was 64% (521 out of 810) and varied by site (from 50% to 83%). About 24% of patients (123 out of 521) declined CI referral; this also varied across sites (12-45%). The median age of patients where CI referral was not considered was 80 years - significantly higher than the group where CI referral was considered (73 years). CONCLUSIONS: CI referral is dependent on where adults live, and how old they are. Older adults are significantly less likely to be considered for CI referral by Audiologists. Audiology clinics need more support to empower staff to talk to patients about CI referral.
RESUMO
Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthesia (GA), precluding patients who have higher risk associated with GA. Recent literature describes the safety and efficacy of performing unilateral CI surgery under local anaesthesia (LA). We report the first simultaneous bilateral CI under LA in the UK in an adult patient with profound sensorineural deafness and visual impairment.Case study: A 46-year-old gentleman, registered blind, presented with a 20-year history of bilateral progressive hearing loss. He was assessed as unfit for surgery under GA due to significant cardiac comorbidities. We performed simultaneous bilateral CI surgery under LA on the patient; he was discharged home the following day. Postoperative free field audiometry showed a significant improvement; speech discrimination using Bamford, Kowal and Bench sentences presented in quiet, increased from 0% pre-operatively to 100% four months post-operatively.Conclusion: Simultaneous bilateral CI surgery under LA is a safe and feasible procedure for eligible patients who may otherwise have been denied surgery due to their GA risk.
