Cochlear Implant Evaluation Toolbox: Incentives and Obstacles to the Routine Use of Outcomes Measures by Clinicians


By Kyle Longwell, Product Manager – Software and Clinical Care at Cochlear

Recent studies1,2 support the notion that patient outcomes don’t only include a speech score – the incorporation of patient-focused satisfaction and quality-of-life metrics within the cochlear implant evaluation toolbox may contribute to a more holistic assessment of candidacy and clinical outcomes following implantation.

Data from the CI532 Clinical Study suggests that patient satisfaction measures may more accurately reflect a candidate’s real-world experience in noise and other listening situations, and should therefore be considered as a standard CI candidacy evaluation tool.1 Professionals can use patient-focused assessments like the Speech, Spatial and Qualities of Hearing Scale (SSQ-12) to inquire about aspects of the patient’s ability and experience hearing/listening in different situations. Also, the Client Oriented Scale of Improvement (COSI) is used post-operatively to document the patient’s goals/needs and measure improvements in hearing ability.

Clinicians who participated in a recent CI532 study feedback gathering session reported substantial change to their viewpoints on the 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 indicates that most clinicians are very likely or somewhat likely to include SSQ-12 in their practice in the future.

Another appointment tool, the COSI test, is an open-ended, individualized measure in which each patient nominates the situations in which he or she would most like to be able to better hear. At the end of a pre-determined time frame, (be that the next appointment or 3-6 months later), the patient rates against a five-point scale the degree of improvement, and the final ability to hear in each of those individual situations.

Further, survey responses from 50 clinicians collected by Dillon and So2 highlight the positive aspects of using COSI to measure outcomes over time:

  • Goals and expectations: Clinicians indicated that they valued the way COSI helped them check on the patients’ goals at the outset of the rehabilitation program. The COSI test:
    • Helped individualize the rehabilitation program which would not have otherwise been possible
    • Assisted the clinician and patient by discussing appropriate device use (i.e. accessories) throughout their visit schedule
    • Provided additional insight into the patient’s expectations from the outset
  • Outcome measure and residual need: Clinicians liked having a measure of success at the end of the rehabilitation program. Participants noted that it brought a sense of closure when appropriate and helped to continually identify areas that may still need work in order to plan future appointments accordingly.
  • Rapport and concern: Clinicians reported that the use of COSI helped convey to the patient that a good outcome could be achieved in situations that are important to each individual patient. It can help foster a greater rapport with patients, demonstrating that the professional is listening to the needs of each patient and documenting their satisfaction more closely. It provides a personal touch and way to track progress.
  • Patient involvement: Clinicians have reported that the use of COSI increases the involvement of the patient, and in turn, the likelihood of a good outcome. It gives the patient some ownership in their participation in the rehabilitation program.

These studies suggest that tools like SSQ-12 and COSI can improve the way professionals deliver care, incorporating more patient-focused satisfaction and quality-of-life metrics in the clinic.

To learn more read the study and watch this Cochlear NEXT Youtube playlist.


  1. Data on file – CLTD5446: Clinical investigation of the Nucleus CI532 cochlear implant
  2. Dillon, H., So, M. 2000. Incentives and Obstacles to the Routine Use of Outcomes Measures by Clinicians. Ear & Hearing 2000; 21; 2S-6S.
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