A Survey of Current Audiology Practice in Adult Cochlear Implant Programs and Its Impact on Access to Care

Recent expansion of cochlear implant (CI) indications by Medicare to include patients with better preoperative speech recognition and by the United States Food and Drug Administration to include patients with single-sided deafness and asymmetric hearing loss has increased the number of patients who are candidates for a CI. This expansion has the potential to raise the demand for audiological services related to CI, including preoperative determination of CI candidacy and postoperative programming and evaluation of performance. In this study, we evaluated ways that audiological care facilitates or impedes access to care for adult CI candidates and recipients in CI programs across the United States. Such information will help determine if audiologists will be able to meet an increased demand for services resulting from these recent expansions in CI candidacy.

An electronic survey containing a total of 48 questions presented in either multiple choice or rank order format was distributed electronically and promoted on social media to audiologists working with adult CI candidates or recipients. Responses were collected from November 29, 2023, to January 16, 2024. The survey included questions regarding pre- and postoperative CI care provided to adults. Of these 48 questions, 21 were related to CI access and included appointment availability and wait times, appointment schedules and duration, procedures used to triage the need for follow-up care, and provision of telehealth. This article focuses on responses for the 21 questions related to CI access.

Anonymous surveys were fully or partially completed by 209 audiologists who manage adult CI candidates and recipients in a variety of settings and revealed a variety of findings related to patient care. Results indicate that 54% of clinicians report the preoperative process occurs over 2 separate appointments, and most clinicians (53%) report they always or frequently use a CI manufacturer to assist with preoperative device education and selection. In regard to postoperative care, the median number of times clinicians see patients in the first year is 6, with a range of 3 to 10 appointments. In regard to appointment duration, device activation was the longest (median = 101 min). The 4 appointments reported to occur most often after activation included 1-, 3-, 6-, and 12-mo appointments and these ranged in duration from 81 to 84 min. A comparison of the results of this study with previous reports indicates that several recent changes have taken place in CI care, including reduced pre- and postoperative appointment schedules, utilization of procedures to reduce time spent providing nonbillable services, and some utilization of telehealth.

Recent changes in CI service delivery have the potential to improve access to care for CI candidates and recipients. Such enhancements are necessary to meet the increased demand for audiological services that may result from recent expansions of CI candidacy. Areas that hold promise for further improvements include continued evaluation and refinement of pre- and postoperative appointment schedules, development of procedures to guide decisions regarding if and when patients need to be seen for follow-up care, and increased utilization of telehealth.