Improving access for adult cochlear implantation

Abstract

In this issue of the journal the article by Kumar et al.¹ highlights the barriers faced by potential adult cochlear implant (CI) candidates in New South Wales, and how application of the Living Global Guidelines for Cochlear Implant (LGGGCI) framework might address identified issues.²

Since the pioneering work of Graeme Clark in 1978 to develop the multi-channel CI, and through continuous research and development supported by Cochlear Ltd., cochlear implantation has been shown to be effective in enabling congenitally deaf children to develop speech and language³ and is recognized as ‘the treatment of choice’ for adults with severe to profound hearing loss.⁴

The hearing outcomes achieved with CI continue to improve and hence candidacy for benefit with an implant continues to expand. However, although Australia is in fact a global leader in terms of access, as pointed out by Kumar et al., access to CI services is not universal for all potential candidates. While over 95% of children who can benefit from implantation do receive intervention, possibly as few as 10% of potential adult candidates currently receive a CI.

Despite the remarkable success of CI and associated publicity, there remains a dramatic lack of awareness across the general community, audiological and medical professions—including Otolaryngologists—as to specifically who can benefit from CI and who therefore should be referred as a potential candidate. The lack of awareness and access is an international problem as highlighted by Buchman et al.⁵ This systematic review and consensus statements, were the first steps toward the development of international guidelines on best practices for cochlear implantation in adults with sensorineural hearing loss.

As noted by Kumar et al. the recent publication of Living Global Guidelines for Cochlear Implantation supports the international creation of national guidelines, including for Australia. Australian and New Zealand CI guidelines are currently being prepared and once released will, hopefully, be supported and adopted by all relevant professional bodies, tertiary institutions and industry. In this way, Federal and State governments can be encouraged to address the barriers to CI access—approachability, acceptability and availability of services—as identified by Kumar et al.

However, while ensuring access to candidacy is an important first step improving outcomes for adults, it is critical that implant recipients can be assured of having ongoing access to the rehabilitative services that have been shown to be necessary for their long-term management.