By guest author: Brian Taylor, Au.D.
Cochlear implants (CI) are the standard treatment for bilateral, severe to profound sensorineural hearing loss. It is estimated there are over 30,000 recipients implanted per year worldwide (Vaerenberg, et al 2014). Yet, cochlear implant audiologists remain a subspecialty within the audiology profession. In many medical centers in the United States, cochlear implant audiologists work primarily with children and adults with severe-to-profound hearing loss, participating in the identification, selection, and rehabilitation process of cochlear implantation. Survey data indicate that cochlear implants specialization is confined to a small number of audiologists, as only approximately 11% of audiologists self-identify as working with cochlear implants. This shortage of CI audiologists is likely to have an impact on access to care, but it provides an opportunity for audiologists to participate in the care of adults with severe-to-profound hearing loss, beyond fitting hearing aids.
This schism between cochlear implant audiology and other types of clinical audiology is not without merit. Historically, many of the skills required in the cochlear implant clinical realm, such as mapping of an implanted medical device, CI candidacy selection, counseling and surgical considerations are unique relative to other areas of clinical audiology. However, as cochlear implant candidacy requirements have become less restrictive, and as the programming and adjustment process (known as mapping) has become more automated, there are increasing opportunities for audiologists, who are not cochlear implant specialists, to more fully participate in the care of adults with severe hearing loss.
This blog series debunks myths that, until now, have prevented more audiologists from getting involved in the care of CI users—and makes the case for why private practice audiologists should get involved in the process of providing care to these patients.
Myth #2: There are a small number of adults with severe-to-profound hearing loss who could benefit from a cochlear implant.
The exact number of individuals with severe-to-profound hearing loss varies. Blanchfield, et al (2001) estimated that approximately 738,000 Americans had severe-to-profound hearing loss, with seniors aged 65 and older representing 54% of this population. Alice et al (2013) reported between 0.6 to 1.1% of the general population has a severe-to-profound loss, which cannot benefit from a hearing aid. Additionally, it is expected that the prevalence of severe-to-profound hearing loss will more than double in the next 30 to 40 years, mainly due to an aging population.
Another recently published study examining the prevalence, characteristics, and treatment patterns of hearing loss in the U.S., sheds light on the current plight of individuals with severe-to-profound hearing loss. Mahboubi et al (2017) examined the functional capability of individuals with a range of self-perceived hearing difficulties. Of considerable interest, their analysis suggests 2.8 million adults in the U.S. (1.1% of the population) are unable to hear shouting in a quiet room, which likely equates to a severe-to-profound degree of hearing impairment. According to the researchers, moreover, a mere 5.3% of the adults in this category received a recommendation for a cochlear implant. Perhaps even more troubling, of this small percentage of individuals referred for a cochlear implant, just 1 in 5 people, within that small cohort of adults with self-perceived severe-to-profound hearing loss, actually received a CI. Despite solid clinical evidence supporting the effectiveness of CI and insurance reimbursement for the procedure, the low rate of referral for a CI evaluation in this study is consistent with previous estimates of a 5% utilization rate in the eligible adult population with severe-profound hearing loss. This low CI uptake rate is an opportunity for otolaryngologists and audiologists to raise awareness among primary care physicians and the general population about the benefits of cochlear implants.
Another consideration are the long-term ill-effects of untreated (or inadequately treated) hearing loss in adults with severe-to-profound hearing loss. Data suggest that individuals with severe-to-profound hearing loss are vulnerable to several negative consequences resulting from their condition. Adults with severe-to-profound hearing loss have lower family incomes, are less educated, and are more likely to be unemployed than the general population (Blanchfield, et al, 2001). Thus, improved access to cochlear implantation and related interventions is warranted.
Perhaps more germane to clinical practice, there is ample evidence suggesting most hearing aid dispensing centers are already serving a substantial number of adults with severe-to-profound hearing loss. Numerous studies report a range between 6.7% and 13.5% of an audiologist’s clinical caseload has a severe-profound hearing loss (see Turton & Smith, 2013 for a review of these studies). Based on the updated hearing threshold CI candidacy requirements, and lower-than-expected benefit from hearing aids, many of these individuals already seeking assistance from a non-CI audiologist would be considered candidates for cochlear implants. Unfortunately, many of these individuals, because they don’t have access to a clinic specializing in CI, fail to get properly evaluated for implantation. Table 1 provides a summary of these important data points that underscore the need for mainstreaming cochlear implants into audiology practices.