Neurologists often recommend cochlear implants for people with severe to profound hearing loss who no longer benefit from hearing aids. A person with severe hearing loss is unable to hear raised voices from three feet away; a person with severe hearing loss has the sound of shouting in the ear, According to the World Health Organization.
Despite hearing difficulties, only about 5% of designated U.S. adults receive cochlear implants. In recent years, indications have expanded.this Market size of 2 million patients This includes adults who may retain some residual hearing after surgery, which can be amplified by hearing aid technology. However, from 2000 to 2019, only about 100,000 adults in the United States underwent CI surgery. National Institute on Deafness and Other Communication Disorders.
Instead, many patients cobble together a solution that consists of hearing aids (which offer limited amplification), lip reading, captioning apps and, in some cases, sign language. They have difficulty communicating in professional and social situations.
After studying this situation, we agree with the recently published peer-reviewed literature patient treatment barriers Played a major role in low CI penetration in the market. Our analysis takes the literature one step further – we argue that uncertainty surrounding cochlear implant outcomes is a major factor inhibiting adult adoption.
Cochlear implants use surgically placed electrode arrays
A neurologist under general anesthesia administers a cochlear implant to a patient over a one to two hour procedure. During surgery, the neurologist places the core of the CI device (the electrode array) into the inner ear or cochlea.
Once in place, the device’s external microphones capture sound from the environment, the processor converts the sound waves into electrical impulses, and the electrode array transmits the impulses to the brain’s auditory nerve, enabling hearing. After surgery, CI recipients need one to two years of rehabilitation to train their brains to recognize new sounds.
However, despite this potential hearing miracle for patients with severe hearing loss, only a small percentage of eligible adults choose to continue treatment.
Cochlear Implants Have Wide Range of Outcomes
To explore the reasons behind the low adoption rates, we curated, analyzed, and synthesized recent contributions to the peer-reviewed hearing health literature.One of these studies on Adult CI Results Mining from multi-institutional databases.
The paper showed that the median patient’s word recognition rate increased from 15% before implantation (wearing a hearing aid) to 56% 12 months after implantation. The top 25% of patients with postoperative word recognition scores of 75% or higher are likely to experience a significant improvement in quality of life due to better hearing.
However, the entire study population experienced a wide range of outcomes, from 0% to 100% postoperative speech recognition. In other words, some patients could not recognize any words at all 12 months after surgery, while others had mostly normal hearing. Additionally, the bottom 25% of patients had word recognition scores of 40% or lower 12 months after surgery, which is essentially the dividing line for Medicare to undergo surgery first.
We conclude that this broad range of speech perception outcomes translates into considerable uncertainty for patients. Although clinicians may suggest that patients with higher preoperative speech recognition skills generally achieve the best outcomes, patients may still have difficulty making an informed decision. For example, how did their history of hearing loss and willingness and ability to undergo rehabilitation affect their expected outcomes? Patients lack a mechanism to predict their outcome.
Uncertainty of results raises concerns for patients
Our analysis suggests that the uncertainty in outcomes that patients face helps explain their concerns about cochlear implantation.we checked A recent study The study surveyed 52 patients at one center, including those who opted for cochlear implants and those who opted out. We found that 3 of the top 5 patient-reported questions related to CI were related to hearing outcomes:
- “The cochlear implant did not significantly improve my communication skills.”
- “I didn’t want to risk losing my appreciation for music.” (Due to the technical limitations of CI, some people have lost the ability to appreciate music.)
- “My current hearing aids meet my needs.”
Our view is that many patients are concerned that CI will not improve communication skills and music appreciation any better than their current hearing aid solutions.we believe Outcome uncertainty is the top barrier to patients Have a cochlear implant.
CI Center can develop personalized risk/benefit analysis
There is currently a gap in the industry conversation about how uncertainty about outcomes drives cochlear implant decisions in adult patients. As a first step, cochlear implant manufacturers and surgical centers will benefit from assigning higher priority to resolving outcome uncertainty.
Specifically, we see three significant opportunities for the American Cochlear Implant Center. These initiatives will support adult patients and help them make informed decisions:
- Develop center-level data to summarize patient outcomes and expected recovery timelines
- Graphing individualized risk/benefit analysis for patients
- Create a center-level advocacy team that includes patients
Cochlear implants have the potential to significantly improve a patient’s quality of life, both personally and professionally, by restoring hearing. Addressing uncertainty about outcomes will help CI centers better address adult patient concerns and deliver on the promise of hearing.
Photo: bernie_photo, Getty Images
