• World-first consensus paper published today in Jama Otolaryngology recommends ‘minimum international standard of care for cochlear implantation’, including diagnosis, referral, treatment and aftercare for adults living with severe to profound sensorineural hearing loss1
• Associate Professor of Audiology at the University of Auckland, Holly Teagle was part of a global panel of 31 ear nose and throat surgeons and audiologists, and seven hearing organisations, calling for improved standards in adult hearing care.
• The paper provides reason for optimism for up to 4,500 New Zealand adults living with severe to profound hearing loss2 and clear guidance for hearing health professionals1
The first ever global consensus on the use of cochlear implants for the management of adults living with hearing loss was published today in Jama Otolaryngology.1
The paper was authored by a new panel, including 31 hearing experts from surgical and audiology backgrounds representing more than 13 countries. The authors also consulted representatives from worldwide patient and professional societies.1
According to Associate Professor Holly Teagle, and co-author of the consensus paper/member of the International Cochlear Implant Advocacy Alliance, the publication is a major step forward in the treatment of hearing loss in New Zealand.
“This consensus document will help create clinical best practice guidelines that will lead to a standard of care which is currently lacking for adults living with a severe hearing disability. In New Zealand, while we are performing well against many of the statements in the document, due to our limited funding resources for adults, we are not implanting adults in a timely manner which is impacting their quality of life and hearing outcomes.”
Auckland teacher, Mark Newman, met the clinical criteria as set out in the consensus document for a cochlear implant, but due to the strict funding criteria in New Zealand, was unable to access a publically-funded implant.
“I started losing my hearing 21 years ago, but in 2017 it got to the point where I could no longer hear the children in my class. I was referred to the cochlear implant program but was told that although I clinically met the criteria for an implant, due to the funding restrictions I would not get one.
“At that point, I was terrified I would lose my job, so I decided I would fundraise for a Cochlear implant through Facebook and Givealittle. I managed to raise enough money to get my first implant in December 2017, then in December 2019, I took out a loan through GEM finance for my second one. If I had not funded my implants I would have lost my career. I’d already lost my social life and enjoyment of music, I wasn’t prepared to lose anymore.”
According to Lee Schoushkoff, CEO of the Northern Cochlear Implant Trust, the consensus paper is a major landmark in the treatment of severe to profound hearing loss.
“Before now, there has never been an international agreement on the best way to diagnose and treat severe to profound hearing loss in adults. This paper outlines the first ever-global consensus on how we can optimise hearing care for adults. The recommendations for surgeons, audiology experts and healthcare providers are crystal clear. But we also need the appropriate resourcing from the government to enable us to meet the standard of care adults living with a severe hearing disability deserve.”
Though cochlear implants are an effective medical intervention for many adults living with severe to profound sensorineural hearing loss3, conservative estimates suggest that no more than 1 in 20 adults who could benefit from a cochlear implant have one.4,5
To view the consensus paper, including the full methodology and consensus statements, click here [insert link to journal / www.adulthearing.com].
NOTES TO THE EDITOR
About the consensus process1
The consensus process began with a systematic literature review to identify relevant studies in the subject area. These were used to inform the development of evidence-based draft consensus statements. The draft statements then entered the Delphi voting process, which involved three anonymous voting rounds.
All members of the steering committee and the Delphi consensus panel, except the Chair, were able to vote as part of the Delphi process. Voting on the draft consensus statements took place over three rounds. Consensus was defined as agreement by a least 75 percent of respondents. During this process, all panel members had access to a report of the evidence from a systematic literature review, including the results of the quality assessment of included studies.
The consensus paper includes 20 statements covering seven categories for adults with severe, profound, or moderate sloping to profound hearing loss in both ears. The panel members, following consultation with a Consumer and Professional Advocacy Committee (CAPAC) agreed upon each statement. Categories include:
1. Level of awareness of cochlear implants
2. Best practice clinical pathway for diagnosis
3. Best practice guidelines for surgery
4. Clinical effectiveness of cochlear implants
5. Factors associated with post-implantation outcomes
6. The relationship between hearing loss and depression, cognition and dementia
7. Cost implications of cochlear implants.
About the authors
The Delphi consensus process on unilateral cochlear implantation in adults with bilateral severe, profound, or moderate sloping to profound sensorineural hearing loss was guided by a non-voting Chair, Dr Craig Buchman, Head of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, U.S. The Chair was supported by four steering committee members who were able to vote: Professor René Gifford, Vanderbilt University, Nashville, U.S.; Dr David Haynes, Vanderbilt University, Nashville, U.S.; Professor Thomas Lenarz, Medical University of Hannover, Germany and Professor Gerard O'Donoghue, University of Nottingham, UK.
The voting members of the Delphi panel also included 26 experts in the field of cochlear implant use, including audiologists and ear, nose and throat specialists from across 13 countries.
In addition, a Consumer and Professional Advocacy Committee (CAPAC) of international cochlear implant user and professional advocacy organisations was involved in the development of the consensus statements.
*Hearing loss severe enough to have great difficulty hearing and taking part in conversations in noisy environments.
The Delphi process and medical writing have received funding support from Advanced Bionics, Cochlear Ltd, Med-El and Oticon Medical. The funding organizations did not contribute to the design, facilitation or content of the Delphi consensus process.
1. Buchman CA et al. [insert publication citation] 2019; XXXX
2. Global Burden of Disease Hearing Loss Expert Group. Eur J Public Health 2013;23:146–52.
3. Gaylor JM, Raman G, Chung M, et al. JAMA Otolaryngol Head Neck Surg. 2013;139(3):265-272.
4. Sorkin D. Cochlear Implants Int 2013;14(Suppl 1):S1.
5. De Raeve L. Eur Ann Otorhinolaryngol Head Neck Dis 2016;133(Suppl 1):S57–60.