Meredith Holcomb

To evaluate cochlear implant (CI) speech perception and usage outcomes in patients after prolonged unilateral deafness. Retrospective cohort study at five tertiary academic centers of adult patients with prolonged (> 10 years) unilateral severe to profound hearing loss who underwent cochlear implantation. Main outcome measures included post-operative word recognition scores (WRSs) and average daily usage of CI. A total of 68 patients were analyzed with a median duration of unilateral deafness of 17 years (IQR, 12-35 years). The mean individual average daily CI usage was 8.4 h (SD, 4.5 h) at ≤ 1 year after implantation and 7.1 h (SD, 5.0 h) at > 1 year. The majority of patients (54.5%, 30 patients) had an absolute increase in WRS of ≥ 20% after implantation and 32.7% (18 patients) had an absolute increase of ≥ 50%. Univariate analysis comparing pre- and post-operative speech recognition in patients who completed the same test revealed a clinically and statistically significant improvement, with a mean change of 28.4% (SD 31.6%; p < 0.001) at their latest audiogram. In the analysis excluding those without post-operative data, duration of deafness was not predictive of post-CI WRS on multivariable analysis. Most patients with prolonged unilateral auditory deprivation in our study benefited from a CI. Although the duration of auditory deprivation was found to be inconsistently associated with poorer CI speech perception performance, our findings support individualized CI candidacy assessment and suggest that prolonged deafness alone should not be used as an absolute exclusion criterion for cochlear implantation.

The primary aim of this study was to examine adult pre-cochlear implant (CI) Spanish assessment tools and CI provider practice patterns used in Spain and Spanish-speaking countries in Latin America.   Methods: This study is a cross-sectional survey directed to CI providers who assess CI candidacy in countries where Spanish is the primary language. Results: A total of 51 respondents were included in the study. Respondents represented eleven countries, 10 from the Latin American region, and one from Europe—Spain. The majority of respondents were audiologists (N=31/51, 60.7%) and most respondents worked in a private practice setting (N=37; 68.6%). For speech perception testing during CI evaluation, the majority of respondents use bisyllabic words (N=42/47; 89.4%) and nearly half (N=23/47; 48.9%) endorsed use of recorded materials. Fewer than half of respondents reported using hearing-specific (N=20/42; 47.6%) or tinnitus-specific (N=19/41; 46.3%) patient-reported-outcome- measures (PROMs) in CI assessments. Conclusions: Our findings suggest that bisyllabic words are the preferred and most commonly used tool for aided speech perception testing, aligning with regional guidelines and protocols in Spanish-speaking countries. Opportunities to improve quality of care include expanding the use of recorded materials for unaided and aided speech recognition testing and PROMs to capture the functional, emotional and social impact of hearing loss prior and after cochlear implantation. Additionally, the development of standardized guidelines and protocols that can be disseminated broadly would help ensure consistent assessment practices and improve care for Spanish-speaking patients worldwide.

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes.

Hearing loss is a highly prevalent disease state affecting almost 1 in 5 individuals globally. Growing research shows that untreated or undertreated hearing loss carries significant long-term sequelae, including increased risk of social isolation, depression, and cognitive decline, among other ramifications. Limited awareness and common misperceptions among the general US adult population and primary care providers contribute to low rates of referral to hearing specialty clinics and underutilization of hearing aids, cochlear implants, and other rehabilitative devices. Comprised of diverse membership, the Hearing Health Collaborative (HHC) was formed in May 2021 to identify and overcome challenges impacting good health care practices and public policy on hearing care in connection with healthy aging. This editorial documents a recent outcome of the HHC derived from a structured A3 process. Specifically, initiative 2, a proposal to develop a simple, clinically anchored staging system primarily for use by frontline providers and patients, is presented. Unlike other common disorders that harbor long-term health sequelae, a corresponding pragmatic clinical staging system-leveraging precedent disease staging convention, based on clinically meaningful outcomes and prognosis for acquired hearing loss-does not exist. The development of this staging system will potentially allow for improved communication across providers and patients, facilitate referral pathways, and ultimately enable patient access to timely and appropriate care.

Single-sided deafness (SSD) treatment options include Contralateral Routing of Signal (CROS) or Bilateral Routing of Signal (BiCROS) systems, bone conduction devices, cochlear implants (CIs) and no intervention. Aligning treatment recommendations with patient motivations is fundamental for satisfaction and successful outcomes. At our institution, a structured telehealth consultation precedes formal testing and includes treatment motivation exploration and comprehensive review of all interventions. This study examined SSD treatment motivations and their association with pursuing cochlear implantation. Adults who completed a pre-treatment SSD telehealth consultation over a four-year period were identified. Charts were retrospectively reviewed for demographics, SSD characteristics, treatment motivations, treatment choice, and CI outcomes. A total of 122 adults were evaluated. Mean age was 56.3 (±13.0) years, and 59.8% were male. Mean SSD duration was 10.8 (±15.8) years. The most common etiology was sudden sensorineural hearing loss. The top primary motivations were improving overall hearing (23.0%), restoring hearing to the deaf ear (22.1%), and improving hearing in noise (21.3%). Most patients (45.1%) opted for a hearing aid, CROS or BiCROS system; 38.5% chose CI; and 14.8% declined treatment. Only 57.4% of those who selected CI had the implant, primarily due to surgery avoidance (31.5%) and insurance limitations (10.5%). Motivation did not predict treatment choice or CI receipt. Among CI recipients ( = 27), those motivated by hearing restoration demonstrated poorer speech outcomes and datalogging. Improving overall hearing and restoring hearing to the deaf ear were the most common motivations for seeking SSD treatment. Adult CI recipients had similar motivations to those who chose non-surgical options.

Cochlear implantation often requires frequent post-operative programming visits which can disrupt daily life, impose financial burdens, and delay access for new cochlear implant (CI) candidates. This study evaluated the feasibility of a de-escalated schedule of four programming appointments within the first year after surgery.
A retrospective review was completed for 236 patients aged 0-100 years who received CI from July 2022 to December 2023. Explants, reimplants and second CI within the study window were excluded. Collected data included demographics, schedule adherence, additional visit reason, and Consonant-Nucleus-Consonant (CNC) word scores for adults.
A total of 201 CI recipients (mean age 46.9 years; 72.6% adults) met inclusion criteria. Most were male (53%), White (88%), Non-Hispanic (54.7%), and privately insured (56.2%). Overall, 53% adhered to the 4-visit protocol, 35% required 1-2 additional visits, and 12% required 3-6. Among those requiring additional appointments (n = 95), 28.4% followed the prior protocol of up to 10+ visits. Adherence to the new streamlined protocol improved by 43% over the study period. On multivariate analysis, each additional year of age at surgery reduced the odds of adherence by 3.4% (p < 0.05). No statistical or clinical differences were observed in 12-month CNC scores between patients with ≤ 4 versus > 4 visits.
A de-escalated post-CI programming schedule of four visits in the first year is feasible and does not compromise adult speech perception outcomes. Older patients may require closer follow-up. Successful implementation may require time for workflows and provider adoption.

Background/Objectives: Spanish-speaking patients face persistent barriers in accessing equitable audiological care, particularly when standardized language-appropriate tools are lacking. Two Spanish-language sentence recognition tests, the Spanish AzBio Sentence (SAzB) and the Latin American Hearing in Noise Test (LAH), are commonly used to evaluate speech perception in adults with hearing loss. However, performance differences between these measures may influence referral decisions for hearing intervention, such as cochlear implantation. This study compared test performance under varying noise and spatial conditions to guide appropriate test selection and reduce the risk of misclassification that may contribute to healthcare disparities. Methods: Twenty-one bilingual Spanish/English speaking adults with normal bilateral hearing completed speech perception testing using both the SAzB and LAH. Testing was conducted under two spatial configurations: (1) speech and noise presented from the front (0° azimuth) and (2) speech to the simulated poorer ear and noise to the better ear (90°/270° azimuth). Conditions included quiet and three signal-to-noise ratios (+10, +5, and 0 dB). Analyses included paired t-tests and one-way ANOVAs. Results: Participants scored significantly higher on the LAH than on the SAzB across all SNR conditions and configurations, with ceiling effects observed for the LAH. SAzB scores varied by language dominance, while LAH scores did not. No other differences were observed based on any further demographic information. Conclusions: The SAzB provides a more challenging and informative assessment of speech perception in noise. Relying on easier tests like the LAH may obscure real-world difficulties and delay appropriate referrals for hearing loss intervention, including cochlear implant evaluation. Selecting the most appropriate test is critical to avoiding under-referral and ensuring Spanish-speaking patients receive equitable and accurate care.

To highlight the impact of COVID-19 on the timeline from diagnosis to cochlear implantation (CI) for children with congenital hearing loss (HL) at a diverse multidisciplinary cochlear implant center. A retrospective chart review was completed for congenitally deafened children (n = 102) age 0-18 years who underwent first ear CI at our clinic. Patients were stratified into pre- (n = 49) and post- (n = 53) COVID-19 pandemic groups for analysis. Most patients were male (54.9 %), Hispanic (62.7 %), White (72.5 %), and had Medicaid/Managed care insurance (67.6 %). Over half listed English as their primary language (55.9 %) followed by Spanish (38.2 %). Most had an etiology of HL due to hereditary/genetic factors (73.6 %). Initial analyses between demographic factors (e.g., ethnicity, primary language) and outcome variables revealed no significant differences. No significant differences were found in pre- and post-COVID groups in time between HL evaluation and CI evaluation, time between HL evaluation and first ear CI, and in mean age at first ear CI between the pre- and post-COVID groups. Interestingly, differences in time between first HL evaluation at our clinic and second ear CI surgery pre- and post-COVID were found, with patients pre-COVID undergoing their second CI surgery approximately 7 months later than the patients post-COVID (M = 17.66 months, SD = 15.66; M = 10.76, SD = 10.62). COVID-19 did not negatively impact our timeline from diagnosis to CI for children with congenital HL. In fact, time between 1st and 2nd sequential CI improved post-COVID and provided quicker access to binaural hearing. Additionally, our English and Spanish speaking groups had equitable access pre- and post-COVID to audiological and HL treatment services regardless of preferred language. Overall, actions taken to minimize the impact of COVID restrictions allowed our clinic to maintain and, in some areas, improve access to CI for children with congenital HL from a diverse patient population.

ObjectivePresent the rationale for the development of a new, patient-facing vital sign for adult hearing.Study DesignStructured A3 process.SettingFourteen virtual meetings and two in-person meetings held between May 2021 and June 2022.Main Outcome Measure(s)Identification and refinement of a countermeasure to develop and imbed a hearing health vital sign for adult hearing.ResultsThrough a rigorous, structured A3 process, the Hearing Health Collaborative identified and refined the rationale for and the qualities associated with a public-facing vital sign for adult hearing loss. Specifically, such a vital sign must embody five qualities: simple, accessible, stable, inclusive, and meaningful. These qualities together would ensure that a hearing health vital sign would be useful not only as a screening tool but also as an instrument to guide next steps in workup and potentially treatment.ConclusionsSuccessful identification and implementation of a hearing metric or "vital sign" for the presence of adult hearing loss, using precedent convention of other medical diseases, may help reframe public perceptions surrounding hearing loss, improve awareness and literacy regarding the presence of the disease, and prompt action to seek diagnostic assessment.

Recent expansion of cochlear implant (CI) indications by Medicare to include patients with better preoperative speech recognition and by the United States Food and Drug Administration to include patients with single-sided deafness and asymmetric hearing loss has increased the number of patients who are candidates for a CI. This expansion has the potential to raise the demand for audiological services related to CI, including preoperative determination of CI candidacy and postoperative programming and evaluation of performance. In this study, we evaluated ways that audiological care facilitates or impedes access to care for adult CI candidates and recipients in CI programs across the United States. Such information will help determine if audiologists will be able to meet an increased demand for services resulting from these recent expansions in CI candidacy. An electronic survey containing a total of 48 questions presented in either multiple choice or rank order format was distributed electronically and promoted on social media to audiologists working with adult CI candidates or recipients. Responses were collected from November 29, 2023, to January 16, 2024. The survey included questions regarding pre- and postoperative CI care provided to adults. Of these 48 questions, 21 were related to CI access and included appointment availability and wait times, appointment schedules and duration, procedures used to triage the need for follow-up care, and provision of telehealth. This article focuses on responses for the 21 questions related to CI access. Anonymous surveys were fully or partially completed by 209 audiologists who manage adult CI candidates and recipients in a variety of settings and revealed a variety of findings related to patient care. Results indicate that 54% of clinicians report the preoperative process occurs over 2 separate appointments, and most clinicians (53%) report they always or frequently use a CI manufacturer to assist with preoperative device education and selection. In regard to postoperative care, the median number of times clinicians see patients in the first year is 6, with a range of 3 to 10 appointments. In regard to appointment duration, device activation was the longest (median = 101 min). The 4 appointments reported to occur most often after activation included 1-, 3-, 6-, and 12-mo appointments and these ranged in duration from 81 to 84 min. A comparison of the results of this study with previous reports indicates that several recent changes have taken place in CI care, including reduced pre- and postoperative appointment schedules, utilization of procedures to reduce time spent providing nonbillable services, and some utilization of telehealth. Recent changes in CI service delivery have the potential to improve access to care for CI candidates and recipients. Such enhancements are necessary to meet the increased demand for audiological services that may result from recent expansions of CI candidacy. Areas that hold promise for further improvements include continued evaluation and refinement of pre- and postoperative appointment schedules, development of procedures to guide decisions regarding if and when patients need to be seen for follow-up care, and increased utilization of telehealth.