Delegation of Technical Aftercare Following Cochlear Implantation

Cochlear implant (CI) care in Germany is standardized through the AWMF Clinical Practice Guideline "Cochlear Implant Care", the CI White Paper of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC), and established certification structures.

This document, commissioned by the Executive Board of the DGHNO-KHC, provides a professional, organizational, and reimbursement-related framework for the delegation of technical aftercare services based on the CI Clinical Practice Guideline, the CI White Paper, and practical experience from existing guideline-based cooperation models.

The analysis demonstrates that technical aftercare services can be delegated in accordance with the guideline, provided that delegation is initiated by the responsible cochlear implant providing department (CIVE) within a formal cooperation agreement, the patient's informed consent has been obtained, and overall responsibility for the treatment process remains with the CIVE.

Delegation may cover individual or all components of technical aftercare; an "all-or-none principle" does not apply. Medical and complex audiological aftercare, as well as all audiological and technical services of basic and follow-up therapy, remain non-delegable. External service providers have no independent entitlement to perform technical aftercare. Consent to delegation may be withdrawn at any time by either the CIVE or the patient.

Reimbursement for technical aftercare services has not yet been standardized nationwide, mainly because contractual arrangements are still lacking.