September 10, 2020

Global recommendations for cochlear implants outlined

More than 432 million adults across the globe live with a disabling hearing loss, but of those who are candidates for cochlear implants, only 4-5% receive one.

More than 432 million adults across the globe live with a disabling hearing loss, but of those who are candidates for cochlear implants, only 4-5% receive one.

A new paper published in JAMA Otolaryngology aimed to increase awareness of the potential benefits of cochlear implants by developing an international consensus on the best way to diagnose and treat severe to profound hearing loss in adults.

René Gifford, PhD

The paper was authored by a panel of 31 hearing experts from more than 13 countries and included David Haynes, MD, professor of Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center, and René Gifford, PhD, professor of Hearing and Speech Sciences and director of VUMC’s Cochlear Implant Program, as senior authors. Haynes and Gifford also served as two of five members of the project’s steering committee, which voted on the final consensus statements.

“The Bill Wilkerson Center has long been a national and international leader in cochlear implantation. It is fitting that Drs. Gifford and Haynes lend their considerable expertise to this consensus document that has the potential to improve the treatment of adults with severe to profound hearing loss across the globe,” said Anne Marie Tharpe, PhD, chair of the Department of Hearing and Speech Sciences and associate director of the Vanderbilt Bill Wilkerson Center.

David Haynes, MD

Based on a systematic review of the literature and clinical expertise, the paper outlines 20 evidence-based recommendations on unilateral cochlear implant use based on seven interest areas: awareness of cochlear implantation; best practice clinical pathway from diagnosis to surgery; best practice guidelines for surgery; clinical effectiveness of cochlear implants; factors associated with post-implantation outcomes; association between hearing loss and depression, cognition and dementia; and cost implications.

While bilateral cochlear implantation is considered standard of care in many countries, including the U.S., the paper focused on unilateral recommendations so the resultant guidelines could have significant global impact.

The goal of establishing the recommendations was to inform the development of global clinical practice guidelines, which the authors say could increase access to cochlear implants worldwide and improve hearing and quality of life in eligible adults.

“This series of international consensus statements is a critically important first step toward identifying cochlear implantation as ‘standard of care’ for adults with severe, profound or moderate sloping to profound sensorineural hearing loss at the global level. This paper has identified the evidence for the safety and efficacy of this intervention and its cost effectiveness and suggests that this be adopted into global clinical practice guidelines,” said Gifford.

“We need to remove the barriers to this technology, and this starts with a summary of the evidence, consensus, publication and ultimately education of the masses.”

Currently there are no international guidelines on cochlear implant candidacy for adults, and the candidacy criteria vary across countries and even across insurance carriers within a given country.

Many countries do not include hearing assessments as part of an individual’s routine health care, and of those that do, few refer people with evidence of hearing loss to a specialist for further evaluation and treatment.

Although cochlear implants are considered the most successful sensory prosthetic ever invented, utilization remains low — a problem experts blame in part on a lack of awareness by both the public and referring providers.

“This work will ultimately improve the quality of life of those with hearing loss by breaking down current barriers to care,” said Haynes, also director of VUMC’s Division of Neurotology.

“I am very proud that of the five steering committee members of this work, two were from Vanderbilt.”

The paper’s authors recommend their work be expanded by creating international consensus statements for cochlear implantation in children and for bilateral cochlear implantation in adults.

“Vanderbilt performs more cochlear implants than any center in the Western Hemisphere, performs remarkable research which has created internationally acknowledged breakthroughs and has pioneered same-day assessment and surgery,” said Roland Eavey, MD, Guy M. Maness Professor and chair of Otolaryngology-Head and Neck Surgery and director of the Vanderbilt Bill Wilkerson Center.

“The Bill Wilkerson Center shines in this area of coordination for patients and collaboration between the Departments of Hearing and Speech Sciences and Otolaryngology-Head and Neck Surgery.”