Optimizing Cochlear Implant Activation: A Prospective Patient-Preference Study

As many centers around the world are shifting towards earlier cochlear implant (CI) activation, there have been no studies of patient preference on timing. This study aimed to determine patient timing preferences before and after standard 3-week activation and examine factors influencing preference changes.

Prospective survey-based study.

Tertiary care academic CI center.

Adults 18 years of age or older receiving their first CI.

Participants completed questionnaires preoperatively, immediately postoperatively, 1-week postoperatively, and 1-week postactivation. Data included demographics, CI quality of life (CIQoL-10), and device characteristics. Patient-reported outcomes, activation preferences, and rationales for activation timing were assessed.

Change in patient-preferred activation timing from preoperative to 1-week postactivation.

Fifty-two patients (46.2% male) participated. Mean age was 65.6±16.0 years. Preoperatively, most preferred same-day activation (25.5%), followed by the standard 3-week interval (23.5%) and equally at 1 and 2 weeks (17.6% each). The primary rationale was the desire for immediate hearing (38.3%). At 1-week postactivation, preferences shifted toward later activation: 32.6% preferred the standard 3-week timeline versus 8.7% for same-day. One week postoperatively, dizziness was significantly correlated with delayed activation preference ( P =0.033). Patients initially preferring "early" activation (<2 wk) had 2.5-fold increased odds of preferring "standard" activation (≥2 wk) postoperatively (95% CI: 0.97-6.44), though this did not reach significance.

Many CI patients prefer early device activation, yet many adjust their preference postoperatively, likely due to underestimation of surgical recovery. This study highlights the dynamic nature of activation preferences, underscoring the importance of adequate patient counseling and considering patient input before uniformly adopting earlier activation protocols.