Cochlear Implants
by Cochlear Guest Author

5 resources on CI standard of care to help you join the industry conversation

June 4, 2021
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International Consensus Paper

The world’s first international consensus on cochlear implant treatment for adults was published in JAMA Otolaryngology.1 The paper was authored by 31 hearing experts assisted by cochlear implant user and professional advocacy organizations. The publication is a major step forward in clarifying when cochlear implants (CI’s) are a treatment option for adults and a timely call to policymakers, insurance funding bodies as well as health professionals to better understand the importance of providing access to CI treatment for those who could benefit.

  1. Newly published: First-ever global consensus on use of cochlear implants in adults

Read about the first global consensus on the use of cochlear implants for the management of bilateral moderate to profound or moderate sloping to profound hearing loss in adults was published online on August 27, 2020 in JAMA Otolaryngology Head and Neck Surgery.

2. Journal Club – Standard of Care: International Consensus Paper

Check out this International Consensus Paper article review written by Dr. Brian Kaplan, Senior Vice President of Clinical Strategy & Innovation at Cochlear.

60/60 Guideline

Zwolan et al recommends that patients be considered for a cochlear implant candidacy evaluation (CICE) if they obtain a score less than or equal to 60% correct on an unaided monosyllabic word test in the better ear and if they demonstrate a PTA greater than or equal to 60 dB HL.2 The group is hopeful that this simple guideline will result in an increase in the number of patients who are referred for a traditional cochlear implant candidacy evaluation.

3. AudiologyOnline course: Standard of Care: International Consensus and Candidacy Evaluation for Cochlear Implant Use in Adults: An Audiological Perspective

This course focuses on the methodology and findings from a recent international systematic review and consensus process, establishing a standard of care for the treatment of adult patients with unilateral cochlear implant for bilateral severe, profound, or moderate sloping to profound sensorineural hearing loss. It also includes a review of “Terry Zwolan et al Development of a 60/60 Guideline for Referring Adults for a Traditional Cochlear Implant Candidacy Evaluation. Otology & Neurotology: April 20, 2020.”

4. Journal Club: Development of a 60/60 Guideline for Referring Adults for a Traditional Cochlear Implant Candidacy Evaluation

Read this journal club article discussing the new 60/60 Guideline and its importance.

5. New considerations for recommending a cochlear implant evaluation

Traditionally, cochlear implants have been considered a treatment option only for those who have lost all of their hearing. Read how the new 60/60 Guideline may change that.

Join this webinar series to learn more!

  1. Craig A. Buchman, et al., Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss. A Systematic Review and Consensus Statements. JAMA Otolaryngol Head Neck Surg. doi:10.1001/ jamaoto.2020.0998 Published online August 27, 2020 ** Commentary and suggested implications is the work of the authors of the summary. EURO-CIU GLOBAL GUIDELINES ON STANDARDS OF CARE FOR ADULT COCHLEAR IMPLANTATION, Sue Archbold, Brian Lamb and Leo De Raeve.
  2. Zwolan, Teresa A.; Schvartz-Leyzac, Kara C.; Pleasant, Terrence Development of a 60/60 Guideline for Referring Adults for a Traditional Cochlear Implant Candidacy Evaluation, Otology & Neurotology: April 20, 2020 – Volume Publish Ahead of Print – Issue – doi: 10.1097/MAO.0000000000002664

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Cochlear Guest Author

In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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Sarah Hughes

Preventing listening fatigue this holiday season with tips from Dr. Sarah Hughes

December 20, 2021

By Sarah E. Hughes B.Sc., M.H.Sc.,Ph.D., Research Fellow, Centre for Patient Reported Outcome Research, University of Birmingham, United Kingdom

Sarah Hughes

Here are some tips to making sure your patients can be a part of the conversations and moments that they care about the most:

Tips from an expert to manage listening effort during the holidays

As cochlear implant recipients, your patients may find that they are extremely tired by the end of the day. Interestingly, recipients often fail to connect their fatigue with listening and the increased effort needed to ensure listening success.

Listening effort is a term used to describe the exertion of brain power used to pay attention and understand spoken language.

It’s important for recipients to appreciate that listening effort is a part of what it means to listen with a hearing loss. Hearing is something that happens without us being aware of it taking place. Listening, however, is active. It is something we ‘do.’ When listening conditions are favorable this happens easily and we are not aware of the effort involved.

However, when conditions are challenging, such as listening with a hearing loss, a listener is required to do additional mental work to enable them to understand speech, music or identify sounds in the environment.

If recipients expect to listen in the same way as hearing family and friends, they may be putting a lot of added pressure onto themselves. The extra pressure is stressful and can actually be counter-productive. Listening well may be possible in short periods, but over longer periods can become exhausting and can quickly lead to fatigue.

The good news is that recipients tell us when they make the effort to listen with their cochlear implant (s) that they feel a greater sense of social connectedness – the feeling of being in close personal contact with the world around them.

Cochlear™ CoPilot helps with strategies for the holidays

There are a number of strategies that can help manage your recipients’ energy levels for listening. Cochlear CoPilot is a mobile app that features information and insights from experts plus advice from other recipients.

Here are some tips for your patients from Cochlear CoPilot to get started:

  1. Recognize that listening with hearing loss requires effort.
  2. Schedule breaks in advance for times when you know that listening will be intensive or challenging.
  3. Allow yourself downtime to give your brain a listening break. Spend some time doing activities that don’t require you to listen very much – read, exercise, or meditate.
  4. Plan your day so that challenging tasks and activities are scheduled when you have the energy.
  5. Remember that good nutrition and adequate sleep play an important role in managing your energy.
  6. Take a short break when you find yourself straining to listen. This could happen at work, during meetings, social events or even when you are simply tired.
  7. Step away and tune out to reduce stimulation and help to de-stress and refresh.
  8. Prioritize activities that are most important to you during the holiday season such as family get togethers or social events. This will help ensure that you have enough energy for those listening-based activities that are special.

While it might not always be possible to fully schedule the day around upcoming listening demands, having an awareness that listening effort can impact energy level means they will be more likely to take a break from listening when applicable. Planning in advance enables your recipients to be at their best when listening really matters.

To find out more about listening effort, preventing listening fatigue at the holidays and practical tips from other recipients, download Cochlear CoPilot.

About the author: Dr. Hughes is currently a Research Fellow at the Centre for Patient Reported Outcome Research (CPROR) at the Institute of Applied Health, University of Birmingham in the UK. She received her M.H.Sc in speech-language pathology from the University of Toronto, Canada, and her PhD at Swansea University Medical School, Wales, UK where she was a James Callaghan Scholar whose research focused on the development and validation of a new patient-reported outcome measure of listening effort in adult cochlear implant recipients.  Dr. Hughes has worked on several collaborations with the Australian Hearing Hub and the Australian Institute of Health Innovation, Macquarie University, Sydney, Australia, and she is a Core Member of the Adult Rehabilitation Special Interest Group, British Society of Audiology.

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cochlear next

Cochlear NEXT Summary: Clinical Outcomes of CI532 Clinical Study

August 14, 2019

events

In the spring of this year, sixty-five otology and audiology professionals came together for Cochlear NEXT – a program focused on learning and discussion regarding Cochlear’s CI532 Clinical Study and the respective implications of this emerging and impactful data.

Following up on our previous Cochlear NEXT summary regarding surgical outcomes of the CI532 Clinical Study, the following information reviews the primary talking points and output from the day’s second topic – Clinical Care.

Cochlear NextClinical Outcomes of CI532 Clinical Study: A new clinical care approach

Presenters:

Megan Mears, AuD, Clinical Project Manager, Cochlear Americas

Camille Dunn, PhD, Audiologist and CI532 Study Investigator, University of Iowa

Allison Biever, AuD, Audiologist and CI532 Study Investigator, Rocky Mountain Ear Center

Terry Zwolan, PhD, Audiologist and CI532 Study Investigator, University of Michigan

The CI532 Clinical Study provides a wealth of evidence to support the evolving approach to clinical care – for both candidates and recipients. Beginning with an examination of the earliest stages of the patient journey, Cochlear NEXT participants engaged in a robust discussion regarding candidacy, and more specifically, barriers to CI access.

lack of awarenessSimplifying CI candidacy evaluation

There are some generally accepted principles within the CI professional community – notably that a lack of understanding and awareness within the referral community limits the number of patients being formally evaluated for a cochlear implant. In fact, in a live poll, 64% of NEXT participants identified lack of awareness in the referral community as the primary barrier to patient CI access.

Not surprisingly, market data indicates that only 15% of cochlear implant candidates are referred by their general ENT for a CI evaluation1, while only 5% of eligible candidates are implanted2.

To address the awareness concern, a simplified test battery – supported by data from the CI532 Clinical Study, was presented for consideration and discussion. The proposed test battery includes 2 simple metrics – 70 dB PTA (.5, 1 and 2 kHz) and 50% aided speech scores, allowing for non-CI performing professionals to more easily and quickly identify patients to refer to a CI specialist for an evaluation.

The utility of testing hearing in noise as a candidacy measure was also a topic of engaged discussion – pointing to variability and central processing requirements as complicating factors. Based on CI532 study data, it was suggested that patient satisfaction measures (i.e. SSQ12) may more accurately reflect a candidate’s real-world experience in noise and should therefore be considered as a standard CI candidacy evaluation tool.

Following the session, participants reported substantial change in their opinion on the importance of various metrics as a critical component of CI evaluation battery. Most notably, fewer surgeons and audiologists considered sentences in noise to be a vital evaluation metric, while more now consider patient satisfaction to be a key factor during CI evaluation. Feedback during the table discussions indicate that most attendees are very likely or somewhat likely to include SSQ12 in the future.

Enhancing the CI experience for recipients68% satisfied

The session ended with a discussion on bimodal systems and accessory use – addressing key findings of the CI532 clinical study which demonstrated that 68% of study subjects were satisfied or very satisfied with their ability to listen to and appreciate music, with the vast majority of those using the direct streaming capability offered through their Nucleus 7 (N7) processor and compatible GN Resound hearing aid (note – all study participants were fitted with a ReSound hearing aid on the contralateral ear).

Post-event survey data illustrates a significant change in perception among NEXT participants regarding accessory use – with a dramatic increase in those that disagree or strongly disagree that more than 30% of CI recipients use accessories to enhance their listening ability. This allows the opportunity for additional patient counseling and education to promote the use of these impactful tools. Simplifying the accessories, education, guides, and automatic connectivity were key takeaways identified at most table discussions. Meanwhile, human connection and education, whether it be an audiologist, a Cochlear representative, office hours, or support groups, were listed as the most effective resources for counseling patients on accessories.

Summary

There appears to be broad consensus regarding the need for a simplified test battery to address concerns regarding awareness and access within the CI referral and patient communities. Further, incorporating more patient satisfaction and quality of life metrics within the CI evaluation toolbox may contribute to a more holistic assessment of candidacy and clinical outcomes following implantation.  Finally, data collected during the NEXT program indicates that key benefits obtained by regular bimodal and/or accessory use could be more effectively communicated to patients through various resources.

Check out our previous Cochlear NEXT blog post on CI532 surgical outcomes and don’t miss the next installment: Hearing preservation and CI532 Clinical Study outcomes. Subscribe to our ProNews Blog using the panel to the left to ensure you receive new blog post notifications!

References

  1. https://www.cochlear.com/intl/about/investor
  2. Karson R. et al. PSB Market Research: Cochlear Brand Tracker. May 2017. Cochlear data on file.
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