Dr. Haiden Nunn, Au.D., CCC-A is a clinical audiologist specializing in cochlear implants and implantable hearing technology. She earned her Bachelor of Science in Psychology from the University of Georgia in 2015 before completing her Doctor of Audiology (Au.D.) at the University of Louisville in 2019. Dr. Nunn began her career at North Georgia Audiology, where she completed her clinical externship and remained on staff for three and a half years. She currently practices at Athens Oconee Audiology, where she has spent the past several years helping patients navigate their hearing healthcare journey. Dr. Nunn is a professional member of the American Academy of Audiology (AAA), the American Speech-Language-Hearing Association (ASHA), and the Georgia Academy of Audiology (GAA). She is committed to providing compassionate, evidence-based care while staying current with advances in hearing healthcare and cochlear implant technology. Outside of the clinic, Dr. Nunn enjoys spending time with her family, her Cavapoo, Shrimp, and getting lost in a good fantasy novel. A proud University of Georgia graduate, she is always happy to share a “Goooooo Dawgs!” whenever the opportunity arises.
Estimated read time: 7–8 minutes
Learning objectives:
- Examine how to integrate structured support across the cochlear implant journey
- Identify ways to incorporate Cochlear’s Care Team into key clinical workflows
- Discover how to support clinic efficiency while maintaining patient-centered care
I first started working with cochlear implant patients more than seven years ago, and what I very quickly came to realize was that the clinical work was only one part of the case management. Yes, performing the audiologic evaluations, candidacy evaluations, and mapping sessions are at the core of what we do as implant audiologists, but a lot of it takes place behind the scenes. It’s in patient education, emotional support, follow-up care, device navigation, and dare I say, Bluetooth pairings and accessories. Managing and learning all these different components can very quickly go from having a positive and effective outcome to one of consistent frustration and regret. I remember the overwhelm I felt when I started handling my own caseload of patients. There were days where I would get backed up on filling out order forms, discussing upgrades and filling out the necessary paperwork for those, counseling on accessories, Bluetooth, and basic care and maintenance of the equipment, and it would take me hours of administrative time on top of my clinical time to get everything submitted correctly and in a timely manner. I enjoyed seeing these patients, and I loved working with the technology, but the endless amounts of counseling, excess appointments, and paperwork was very quickly making me fall out of love with cochlear implants.
A few years ago, I had the privilege and opportunity to attend one of Cochlear’s in-person trainings. At this training, I learned all about their Adult Implant Protocol and how to utilize their support systems in place. I believe they had been hearing complaints nationwide on how difficult the processes had become, and thankfully they found a solution! Now, I can’t imagine seeing a cochlear implant patient without having this support in place for me and our busy private practice.
I have come to think about this protocol as a philosophy, one that aims to provide best practice for the patient on their hearing journey and keeps them on the path to better outcomes with their cochlear implant. In this article, my objective is to help show how this protocol is implemented into my own practice, and why the support team in place at Cochlear Americas, specifically the Cochlear Engagement Manager, the Recipient Solutions Manager, and the Upgrade Specialist, have become integral and indispensable parts of the care that I provide.
Setting the Stage: Why Structure Matters in Cochlear Implant Care
Cochlear implant patients are a widely diverse patient population, and I have had the pleasure of helping hundreds of patients navigate their hearing journey. I’ve seen patients learn that hearing aids would no longer help and what that means for them moving forward, I’ve seen them fearful of the unknown and what that means for their life, and I’ve seen their family members desperate for them to do anything to help them communicate and enjoy life again. Without proper protocols in place, it would be easy for these patients and their concerns to go unchecked and unnoticed. What would inevitably happen is that they might leave their initial consultation feeling confident and then a few weeks later, they have decided they are no longer going to move forward with it. I’ve seen new recipients who start off enthusiastic and ready to hear only to fall off of their aural rehabilitation and appropriate wear times, and I’ve also seen patients who have been in the same processor for 8 plus years and they come to me distraught because they’ve snapped a coil cable that can no longer be replaced.
Cochlear’s Adult Implant Clinical Protocol addresses all of these issues and more. It helps me guide the patient along their journey from the first consultation, through their implantation, activation, and finally through long-term device management. I’ve found a way to get the patients where I need them with good outcomes and minimal clinic time, and I couldn’t have done it without Cochlear’s Support Team.
Phase One: The Cochlear Engagement Manager: Building the Foundation
The beginning phase of the patient journey is the most delicate. Once a patient is identified as a cochlear implant candidate, I often see emotions ranging from excitement and hope to uncertainty and fear. Choosing to leave behind something they have known their entire lives and take a leap of faith toward something new is incredibly brave. The emotional impact of this decision should never be overlooked.
This is where the Cochlear Engagement Manager (CEM) has become one of my most valued partners throughout the pre-operative process. In my practice, once a patient has been identified as a potential candidate, they leave my office with an appointment already scheduled with the CEM while they wait for their consultation with the surgeon.
This additional touchpoint ensures that the information we discuss during the evaluation process is reinforced and that any additional questions regarding the cochlear implant journey, expectations, and outcomes are addressed. While my focus during the evaluation is on completing the necessary testing and determining candidacy, the CEM works alongside me to help patients feel informed, confident, and comfortable moving forward.
What I have found when incorporating this approach is that the fears and doubts that patients have while they wait on surgery are often significantly diminished. They have a stronger understanding of the process. They feel less overwhelmed, have fewer unanswered questions, and are better prepared to engage in the entire process. This partnership allows me to use my clinical time more efficiently while ensuring patients receive the education, support, and reassurance they need during one of the biggest decisions of their hearing journey.
Phase Two: The Cochlear Recipient Solutions Manager: Creating Confidence and Comfort within Newly Implanted Recipients
Phase two is, in my opinion, the most overwhelming part of the cochlear implant journey. Patients come to me excited, but nervous, as they prepare for activation and begin to imagine what their future may look like with their new hearing technology.
During this phase, I have explored two different approaches for incorporating the Recipient Solutions Manager (RSM) into my workflow: scheduling the RSM visit shortly after surgery while we wait for activation, or scheduling it shortly after activation while we wait for the one-month follow-up appointment.
When I schedule patients with the RSM directly after surgery, I find that they arrive for activation already prepared. Their Cochlear Account is established, their batteries are charged, they understand how to handle their processor, and they are just ready to be activated.
When I schedule the RSM visit after activation, I spend a little more time during my appointment reviewing the basics of the processor and its features, but we do not get bogged down in every detail. The orientation becomes much more streamlined because I know the RSM will continue to support the patient and address any questions or gaps that may arise after they leave my office.
As a private practice audiologist that is part of the Cochlear Provider Network (CPN), time is one of my most valuable resources. I need to provide a thorough, evidence-based activation experience while also keeping my schedule moving and ensuring my patients leave feeling confident and encouraged. Before the introduction of RSM support, my cochlear implant activation appointments often lasted 1.5–2 hours because I was responsible for both mapping and extensive processor education. While this education is critical to patient success, it requires a substantial investment of time and clinical expertise and historically has had little to no reimbursement associated with it.
Now, with the support of the RSM, I am able to focus on the clinical aspects of activation while knowing my patients have an additional layer of education and support. This allows me to complete activations more efficiently, while patients leave feeling prepared, supported, and excited to begin their cochlear implant journey.
Phase Three: Hear Now. And Always
What sets Cochlear apart is their dedication to supporting recipients throughout their entire hearing journey. As part of their lifetime commitment, Cochlear has pledged to be there for the patient through advancements in technologies, continued resources, and support for their recipients for their entire lives. That commitment extends beyond developing innovative sound processors; it also includes creating resources and services that help to make obtaining these upgraded processors possible for their recipients.
When I first began my professional cochlear implant career, I was responsible for navigating every aspect of the upgrade process from beginning to end (and everything in between). When a patient became eligible for a replacement processor, we would need to schedule an additional, extensive appointment to collect all the necessary documentation for insurance submission. Writing letters of medical necessity (LMN), submitting insurance paperwork, and completing order forms required a significant amount of time and effort that I simply just did not have.
I was thrilled when Cochlear introduced this service, and I now utilize it for every patient who is eligible for a replacement processor. My role is simple: I complete the eDoc for the LMN, and the RSM takes care of the rest. It truly is that easy!
After the patient connects with the RSM, I either see them for mapping of their replacement processor, or they have the option to receive their device directly through Ready-to-Wear† delivery.
When I reflect on how this process looked before this support was available, I am incredibly grateful for the resources Cochlear has created for the Cochlear Provider Network. This service has transformed the upgrade experience by making it more efficient and smooth for providers and for the patients.
Ongoing Support: How Cochlear Continues to Provide Support
I have to admit, letting go of the reins in the beginning was challenging. I wanted to make sure my patients continued to receive the highest level of care and had all the information they needed for a successful transition. I worried there would be gaps in their education, delays in communication, or issues with documentation and submissions being completed accurately and on time.
I quickly realized those concerns were unfounded. Cochlear’s Care Team has become, and continues to be, a crucial component of my cochlear implant protocol. Their support, expertise, and dedication have allowed my patients to feel confident and cared for throughout their journey.
Today, I feel supported, my patients feel supported, and together we have created a process that provides a seamless and successful experience for everyone involved.
Views expressed are those of the individual. Consult your hearing health provider to determine if you are a candidate for Cochlear technology. Outcomes and results may vary.
† Ready-to-Wear is available to recipients age 5 or older. The Ready-to-Wear service is not available for hybrid externals and certain implant types. For bimodal recipients with a compatible ReSound hearing aid to take advantage of smart bimodal streaming, they will need to visit their clinician to have the hearing aid and sound processor re-linked.
