American Cochlear Implant Alliance Expands Indications for Cochlear Implantation : The Hearing Journal

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Cochlear Corner

American Cochlear Implant Alliance Expands Indications for Cochlear Implantation

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The Hearing Journal 76(01):p 16, January 2023. | DOI: 10.1097/01.HJ.0000911316.43740.98
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The traditional indications for cochlear implantation (CI) have now been expanded to include patients with profound sensorineural hearing loss in the impaired ear and normal hearing in the contralateral ear, known as single-sided deafness (SSD). As compared with conventional CI candidates with bilateral moderate to profound sensorineural hearing loss, additional considerations for the clinical assessment and management of adult CI candidates apply to those with SSD. The report American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness, which was recently published in Ear and Hearing, examines the current relevant evidence. The report also published the results of a systematic review investigating outcomes of CI on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population.



According to the report, CI is an effective treatment option for adults with SSD. Findings from both the evidence review of the assessment and management of adults with SSD and the systematic review of the effectiveness of CI in adults with SSD, provided guidance for the preoperative evaluation and post-activation assessment and management of adults with SSD.

“The systematic review of published studies found CI use has a high probability (> 75% to 100%) of improving speech recognition in the CI-ear, sound source localization, tinnitus perception, and quality of life for adults with SSD,” the report cites. “The probability of significant improvement in speech recognition in noise was dependent on the target-to-masker configuration—which varied across studies. Investigations are needed as to the optimal target-to-masker configurations and test materials to assess speech recognition in noise clinically.”

The newly approved indications for CI encompass patients with asymmetric hearing loss, including patients with mild to moderately-severe hearing loss (4PTA 31 to 55 dB HL) in the contralateral ear. Most recommendations for preoperative assessment and post-activation management are similar across cases of SSD and asymmetric hearing loss. Patients with asymmetric hearing loss do face extra items for consideration, like “optimal programming methods for the contralateral hearing aid, when to encourage the use of the contralateral hearing aid (e.g., at CI activation versus after a few months of CI use), loudness balancing between the CI and hearing aid technologies, and the influence of different modes of technology on spatial hearing.”

It is important to note that the recommendations discussed in this newly published report are for adults only. For guidance on the preoperative evaluation and postactivation assessment and management of children with SSD, the authors direct readers to other studies.


The report authors state a need for additional research into the patient and device variables capable of influencing the outcomes of CI in adults with SSD. They recommend that more research is also conducted to identify the optimal aural rehabilitation procedures needed by this specific patient population, such as training the implanted ear only, or training both ears.

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