Access to Cochlear Implantation: Trends in Surgeon Volume and Training

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Device Technology

Background:

• Cochlear implantation (CI) is a complex surgical procedure for hearing restoration.
• Understanding surgeon training is crucial for optimizing CI outcomes and access.
• High-volume CI surgeons are predominantly fellowship-trained in otology/neurotology (O&N).

Purpose of the Study:

• To evaluate the training backgrounds of surgeons performing a high volume of cochlear implants (CIs).
• To estimate the ratio of otology/neurotology (O&N) providers to traditional CI candidates and audiologists.
• To inform strategies for addressing CI underutilization.

Main Methods:

• Retrospective review of US surgeon registration data from a CI manufacturer (2021-2023).
• Analysis of CI volume based on surgeon training background.
• Estimation of traditional CI candidate prevalence and audiologist ratios using census, Bureau of Labor and Statistics, and American Speech-Language-Hearing Association data.

Main Results:

• 88-90% of high-volume CI surgeons (≥25-40 CIs/year) had O&N training.
• All surgeons performing ≥100 CIs/year were O&N providers.
• Estimated 3,354 traditional CI candidates per O&N provider, with 32 audiologists per O&N provider (3.5 trained in CI).

Conclusions:

• A significant majority of high-volume CI surgeons possess specialized O&N fellowship training.
• Current O&N provider capacity may be insufficient to meet the demand for CI procedures.
• Recommendations include expanding O&N surgical capacity and increasing the number of CI-proficient surgeons.