The Hearing Loss Association of America (HLAA) announced that the “first global consensus on the use of cochlear implants for the management of adults living with hearing loss” was published in JAMA Otolaryngology1. The paper was authored by a new panel, including 31 hearing experts from surgical and audiology backgrounds representing more than 13 countries. 1

According to Craig Buchman, MD, head of the Department of Otolaryngology at Washington University School of Medicine in St Louis, the consensus paper is a major landmark in the treatment of 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,” Buchman said. “This paper outlines the first global consensus on how we can optimize care for adults with severe to profound hearing loss. The recommendations for surgeons, audiology experts, and healthcare providers are crystal clear.”

The consensus paper included 20 statements covering seven categories for adults with severe, profound, or moderate sloping to profound hearing loss in both ears.1 Each statement was agreed upon by the panel members following consultation with seven representatives from international patient and professional societies. Categories included:

  • Level of awareness of cochlear implants
  • Best-practice clinical pathway for diagnosis
  • Best-practice guidelines for surgery
  • Clinical effectiveness of cochlear implants
  • Factors associated with post-implantation outcomes
  • The relationship between hearing loss and depression, cognition, and dementia
  • Cost implications of cochlear implants

Buchman added, “These recommendations could eventually be developed into clinical practice guidelines. Such guidelines could increase access to cochlear implants worldwide, address disparities in care, and lead to improved hearing and quality of life in adults living with hearing loss who are eligible for a cochlear implant.”

Co-chairs of the Consumer and Professional Advocacy Committee (CAPAC), Barbara Kelley, executive director of HLAA, and Dr Harald Seidler, former president of the German Hard of Hearing Association (1996-2019) and cochlear implant user, praised the potential for the consensus paper to help adults living with hearing loss.

“Hearing loss globally is under-recognized. Millions of people worldwide could benefit from the use of a life-changing hearing devices, such as a cochlear implant. However, due to low awareness and inconsistent standards, up to 95% of adults could be missing out on life-changing technology,” said Kelley.

“This is the first international partnership dedicated specifically to improving care for adults who could benefit from a cochlear implant. The expert knowledge of surgeons and audiologists, combined with the voices of adults living with hearing loss, will go a long way to helping people to better hearing and quality of life outcomes,” added Seidler.

In many countries, adults do not have their hearing assessed as part of regular health check-ups. Of those who receive hearing checks and are diagnosed with severe to profound hearing loss*, few are referred to a hearing specialist to examine whether an implantable hearing device could be the most beneficial treatment option. 3,4

While cochlear implants are an effective medical treatment for many adults living with severe to profound sensorineural hearing loss 5, conservative estimates suggest that no more than 1 in 20 adults who could benefit from a cochlear implant has one. 6,7

Buchman concluded, “This consensus paper could be a tipping point. However, there is much more we need to work on to ensure that adults receive the best care for their hearing loss. It’s up to surgeons, audiology experts, primary care professionals, and healthcare organizations to work together and make these standards a reality.”

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Source: HLAA, JAMA Otolaryngology

About the consensus process1

The consensus process was initiated by a systematic 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.

*Hearing loss severe enough to have great difficulty hearing and taking part in conversations in noisy environments.

All members of the Steering Committee and the Delphi consensus panel, except the chair, were able to vote in the consensus process. Voting on the draft consensus statements took place in three rounds. At each voting round, the statements were voted on anonymously using an online questionnaire. Consensus was defined as agreement by a least 75% 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.

1 Buchman CA, Gifford RH, Haynes DS, et al. Unilateral cochlear implants for severe, profound, or moderate sloping to profound sensorineural hearing loss. JAMA Otolaryngol Head Neck Surg. 2020. DOI: 10.1001/jamaoto.2020.0998

2 Stevens G, Flaxman S, Brunskill E, Mascarenhas M, Mathers CD. Global and regional hearing impairment prevalence: An analysis of 42 studies in 29 countries. Eur J Public Health. 2013;23(1):146–52.

3 Cohen SM, Labadie RF, and Haynes DS. Primary care approach to hearing loss: The hidden disability. Ear Nose Throat J. 2005;84(1):26-44.

4 Raine C, Atkinson H, Strachan DR, Martin JM. Access to cochlear implants: Time to reflect. Cochlear Implants Int. 2016;17 (Suppl 1):42–46.

5 Gaylor JM, Raman G, Chung M, et al. Cochlear implantation in adults. JAMA Otolaryngol Head Neck Surg. 2013;139(3):265-272.

6 Sorkin DL. Cochlear implantation in the world’s largest medical device market: Utilization and awareness of cochlear implants in the United States. Cochlear Implants Int. 2013;14(Suppl 1):S12-S14.

7 De Raeve L. Cochlear implants in Belgium: Prevalence in paediatric and adult cochlear implantation. Eur Ann Otorhinolaryngol Head Neck Dis. 2016;133(Suppl 1):S57–S60.