Evidence for the expansion of adult cochlear implant candidacy.
OBJECTIVE
The primary objective of this study was to determine whether a revision and/or expansion of current audiologic cochlear implant candidacy criteria is warranted.


METHODS
The study design was a retrospective review of postoperative speech perception performance for 22 adult cochlear implant recipients who demonstrated preoperative Consonant Nucleus Consonant word recognition scores of 30% or higher in the best-aided condition. This criterion was chosen to exceed that specified by the North American clinical trial of the Nucleus Freedom cochlear implant system.


RESULTS
The mean preoperative best-aided monosyllabic word score for the 22 patients was 41% correct. The degree of postoperative benefit for the best postoperative condition (electric only or bimodal) ranged from 10 to 68 percentage points with a mean benefit of 27 percentage points for the electric-only condition and 40 percentage points for the bimodal condition. Statistical analyses revealed highly significant differences between preoperative-aided, implant-only, and bimodal performance on Consonant Nucleus Consonant monosyllabic word recognition performance. That is, both postoperative scores--electric only and bimodal--were significantly different from one another and from the preoperative best-aided performance.


CONCLUSIONS
The current results suggest that a large-scale reassessment of manufacturer and Medicare preoperative audiologic candidacy criteria for adults is warranted to allow more hearing-impaired individuals to take advantage of the benefits offered by cochlear implantation.
Gifford
René H
RH
Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA. gifford.rene@mayo.edu
Dorman
Michael F
MF
Shallop
Jon K
JK
Sydlowski
Sarah A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001299:Audiometry; D001309:Auditory Threshold; D019929:Cochlear Implantation / Q000706:statistics & numerical data*; D003054:Cochlear Implants / Q000706:statistics & numerical data*; D034381:Hearing Loss / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008389:Marketing of Health Services; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013067:Speech Perception; D014481:United States