A Five-Year Update on the Profile of Adults Undergoing Cochlear Implant Evaluation and Surgery-Are We Doing Better?

Objective: To characterize the influence of expanding indications on the profile of adults undergoing cochlear implantation (CI) at a high-volume CI center.
Study Design: Retrospective review.
Setting: Tertiary referral center.
Patients: 774 adults undergoing CI evaluation from August 2015 to August 2020.
Main Outcome Measures: Demographics; audiometry; speech recognition; speech, spatial, and qualities of hearing scale (SSQ-12).
Results: Of 745 (96.3%) patients qualifying for implantation, 642 (86.6%) pursued surgery. Median age at evaluation was 69 years; 56.3% were men; 88.2% were Caucasian. Median distance to our center was 95 miles. The majority (51.8%) had public insurance (Medicare, Medicaid), followed by private (47.8%) and military (0.4%). Mean PTA, CNC, and AzBio in quiet and noise for the ear to be implanted were 85.2 dB HL, 15.0%, and 19.2% and 3.5%, respectively. Hybrid/EAS criteria were met by 138 (18.5%) CI candidates, and 436 (77.0%) unilateral CI recipients had aidable contralateral hearing for bimodal hearing configurations. Younger age (odds ratio [OR], 0.96; 95% confidence interval, 0.93-0.99) and non-Caucasian race (OR, 6.95; 95% confidence interval, 3.22-14.98) predicted candidacy. Likelihood of surgery increased for Caucasian (OR, 8.08; 95% confidence interval, 4.85-13.47) and married (OR, 2.28; 95% confidence interval, 1.50-3.47) patients and decreased for those with public insurance (OR, 0.45; 95% confidence interval, 0.29-0.69). A lower SSQ-12 score predicted both candidacy and surgery.
Conclusion: Despite expansions in criteria, speech understanding remained extremely low at CI evaluation. Younger age and non-Caucasian race predicted candidacy, and Caucasian, married patients with private insurance and lower SSQ scores were more likely to pursue surgery.
Competing Interests: Conflicts of Interest: K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas, is on the clinical advisory board for Frequency Therapeutics, and is on the Board of Directors for the American Auditory Society. The remaining authors disclose no conflicts of interest.
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