title: Assessing candidacy for bilateral cochlear implants: a survey of practices in the United States and Canada.
abstract: OBJECTIVE
  There are currently no agreed-upon criteria to establish candidacy for bilateral cochlear implants (CIs). This study categorized practice patterns for establishing bilateral CI candidacy.
  
  
  METHODS
  A postal survey was sent to all practices performing CIs in the United States and Canada. The survey queried centers regarding candidacy criteria for bilateral implantation, testing parameters, definition of 'best aided condition', use of testing in noise, localization, and quality-of-life questionnaires. The survey was resent to non-responding centers 4 weeks after the initial mailing.
  
  
  RESULTS
  The overall response rate was 40%. 'Best aided condition' (70%) and hearing in noise (52%) were used to establish bilateral candidacy, while 45% of centers offered bilateral implants to all candidates. The majority of respondents defined 'best aided' as hearing aids only (57% non-exclusive) or CI and hearing aid together (57%). Only 25% considered a CI alone as best aided. Nearly 5% considered no aiding to be the best aided. Sound localization was used by 8% of respondents for candidacy assessment. Reimbursement affected candidacy decision for 45%. There was variability in stimulus levels (60, 50, 45, and 55 dB), signal-to-noise ratios, and speaker orientations used.
  
  
  CONCLUSIONS
  There are no consistent criteria to assess patients for bilateral CIs. This practice variation makes comparing outcomes across centers challenging and leaves open the possibility of having external standards imposed by regulators or payors. Standardization of candidacy assessment is necessary to develop best practices for bilateral cochlear implantation both to optimize patient outcomes and to ensure the continuity of coverage for these services.
authors.affiliation: The Listen For Life Center at Virginia Mason, Seattle, WA 98111, USA. Seth.schwartz@vmmc.org
authors.forename: Seth R
authors.initials: SR
authors.lastname: Schwartz
authors.forename: Stacey D
authors.initials: SD
authors.lastname: Watson
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Backous
mesh_terms: D000328:Adult; D000367:Age Factors; D001299:Audiometry / Q000379:methods; D002170:Canada; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D003054:Cochlear Implants; D003430:Cross-Sectional Studies; D003638:Deafness / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D018570:Risk Assessment; D013067:Speech Perception / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States