Many adult patients who are good candidates for cochlear implants are missed because of significant variation among audiologists in how patients are preoperatively assessed and unfamiliarity with the most current criteria for identifying patients, a new survey reports.
The survey included responses from 92 US audiologists and the results show a wide variability in their testing methods (JAMA Otolaryngol. Head Neck Surg. 2019 doi: 10.1001/jamaoto.2019.3760. [Epub ahead of print]). For example, when assessing patients for lack of hearing aid (HA) benefit—a fundamental criterion for cochlear implant candidacy—the respondents varied widely in their definitions of the best aided listening condition for assessing implant candidates varied widely among the respondents.
Respondents also varied in how they applied speech-recognition test materials from the Minimum Speech Test Battery. Although 96.2% said they use AzBio sentences in quiet, 88.5% said they use AzBio sentences in noise, and 100% use the consonant-vowel nucleus-consonant, monosyllabic word tests. They also reported inconsistent application of these tests. Most respondents (74%) used a sound pressure level scale while the others (26%) used a hearing level scale, which can drastically impact scores. Further, some test at a single noise level while others employ multiple signal-to-noise ratios.
According to Sandra Prentiss, PhD, the study’s lead author and assistant professor at the University of Miami Miller School of Medicine, these findings highlight the lack of clear guidelines for how best to test patients as well as the lack of familiarity of current criteria for cochlear implantation. Unlike in the past when cochlear implants were available only for patients with severe or profound hearing loss, current criteria expand the indication to those with lesser degrees of hearing loss, she said.
“Cochlear implant candidate hearing profiles look very different now than they did before,” she said. “If a patient is reporting a decreased quality of life due to their hearing and communication abilities, and they were told that they were not a candidate, it is worth seeking a second opinion.”
She emphasized the importance of listening to patients about the impact of hearing loss on their quality of life, and encouraged audiologists and otolaryngologists to refer patients for a cochlear implant evaluation. “Even if a patient…does not meet candidacy, it is better to have them tested and counseled on all potential treatment options and the impact of untreated hearing loss,” she said.
—Mary Beth Nierengarten