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CC BY-NC-ND 4.0 · Semin Hear 2021; 42(04): 311-320
DOI: 10.1055/s-0041-1739281
Review Article

Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery

Ashley M. Nassiri
1   Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
,
John P. Marinelli
2   Department of Otolaryngology - Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
,
Donna L. Sorkin
3   American Cochlear Implant Alliance, McLean, Virginia
,
Matthew L. Carlson
1   Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
4   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding No funding or other support was required for this study.
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Abstract

Persistent underutilization of cochlear implants (CIs) in the United States is in part a reflection of a lack of hearing health knowledge and the complexities of care delivery in the treatment of sensorineural hearing loss. An evaluation of the patient experience through the CI health care delivery process systematically exposes barriers that must be overcome to undergo treatment for moderate-to-severe hearing loss. This review analyzes patient-facing obstacles including diagnosis of hearing loss, CI candidate identification and referral to surgeon, CI evaluation and candidacy criteria interpretation, and lastly CI surgery and rehabilitation. Pervasive throughout the process are several themes which demand attention in addressing inequities in hearing health disparities in the United States.

Keywords

cochlear implant - hearing loss - barriers to care - patient experience - health disparities


Publication History

Article published online:
09 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Cunningham LL, Tucci DL. Hearing loss in adults. N Engl J Med 2017; 377 (25) 2465-2473
    CrossrefPubMedGoogle Scholar
  • 2 NIDCD. National Institute on Deafness and Other Communication Disorders. Quick Statistics about Hearing. . Accessed November 1, 2020 at: https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing#10
    PubMedGoogle Scholar
  • 3 Nassiri AM, Sorkin DL, Carlson ML. Current estimates of cochlear implant utilization in the United States. Otol Neurotol 2021; In press
    PubMedGoogle Scholar
  • 4 Sorkin DL. Cochlear implantation in the world's largest medical device market: utilization and awareness of cochlear implants in the United States. Cochlear Implants Int 2013; ; 14 Suppl 1(Suppl 1) S4-S12
    PubMedGoogle Scholar
  • 5 Sorkin DL, Buchman CA. Cochlear implant access in six developed countries. Otol Neurotol 2016; 37 (02) e161-e164
    CrossrefPubMedGoogle Scholar
  • 6 Rapport F, Hughes SE, Boisvert I. et al. Adults' cochlear implant journeys through care: a qualitative study. BMC Health Serv Res 2020; 20 (01) 457
    CrossrefPubMedGoogle Scholar
  • 7 Varadarajan VV, Sydlowski SA, Li MM, Anne S, Adunka OF. Evolving criteria for adult and pediatric cochlear implantation. Ear Nose Throat J 2021; 100 (01) 31-37
    CrossrefPubMedGoogle Scholar
  • 8 Tolisano AM, Schauwecker N, Baumgart B. et al. Identifying disadvantaged groups for cochlear implantation: demographics from a large cochlear implant program. Ann Otol Rhinol Laryngol 2020; 129 (04) 347-354
    CrossrefPubMedGoogle Scholar
  • 9 Holder JT, Reynolds SM, Sunderhaus LW, Gifford RH. Current profile of adults presenting for preoperative cochlear implant evaluation. Trends Hear 2018; 22: 2331216518755288
    CrossrefPubMedGoogle Scholar
  • 10 Barnett M, Hixon B, Okwiri N. et al. Factors involved in access and utilization of adult hearing healthcare: a systematic review. Laryngoscope 2017; 127 (05) 1187-1194
    CrossrefPubMedGoogle Scholar
  • 11 Cochlear Implant Candidacy for Adults. American Cochlear Implant Alliance. Published 2020. Accessed November 30, 2020 at: https://www.acialliance.org/page/AdultCandidacy
    PubMedGoogle Scholar
  • 12 US Market for Hearing Aids and Audiology Devices. iData Research Inc. 2010
    PubMedGoogle Scholar
  • 13 US Market Report Suite for Hearing Devices. iData Research Inc. 2016
    PubMedGoogle Scholar
  • 14 Gifford RH, Dorman MF, Shallop JK, Sydlowski SA. Evidence for the expansion of adult cochlear implant candidacy. Ear Hear 2010; 31 (02) 186-194
    CrossrefPubMedGoogle Scholar
  • 15 Nassiri AM, Yawn RJ, Gifford RH. et al. Same-day patient consultation and cochlear implantation: innovations in patient-centered health care delivery. Otol Neurotol 2020; 41 (02) e223-e226
    CrossrefPubMedGoogle Scholar
  • 16 Marinelli JP, Carlson ML. Barriers to access and health care disparities associated with cochlear implantation among adults in the United States. Mayo Clin Proc 2021; 96 (03) 547-549
    CrossrefPubMedGoogle Scholar
  • 17 Balkany T, Hodges A, Menapace C. et al. Nucleus Freedom North American clinical trial. Otolaryngol Head Neck Surg 2007; 136 (05) 757-762
    CrossrefPubMedGoogle Scholar
  • 18 Barnes JH, Yin LX, Marinelli JP, Carlson ML. Audiometric profile of cochlear implant recipients demonstrates need for revising insurance coverage. Laryngoscope 2021; 131 (06) E2007
    CrossrefPubMedGoogle Scholar
  • 19 Carlson ML. Cochlear implantation in adults. N Engl J Med 2020; 382 (16) 1531-1542
    CrossrefPubMedGoogle Scholar
  • 20 Semenov YR, Martinez-Monedero R, Niparko JK. Cochlear implants: clinical and societal outcomes. Otolaryngol Clin North Am 2012; 45 (05) 959-981
    CrossrefPubMedGoogle Scholar
  • 21 D'Haese PSC, De Bodt M, Van Rompaey V, Van de Heyning P. Awareness of hearing loss in older adults: results of a survey conducted in 500 subjects across 5 European countries as a basis for an online awareness campaign. Inquiry 2018; 55: 46958018759421
    PubMedGoogle Scholar
  • 22 Disease GBD, Injury I, Prevalence C. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390 (10100): 1211-1259
    CrossrefPubMedGoogle Scholar
  • 23 Mahboubi H, Lin HW, Bhattacharyya N. Prevalence, characteristics, and treatment patterns of hearing difficulty in the United States. JAMA Otolaryngol Head Neck Surg 2018; 144 (01) 65-70
    PubMedGoogle Scholar
  • 24 Livingston G, Sommerlad A, Orgeta V. et al. Dementia prevention, intervention, and care. Lancet 2017; 390 (10113): 2673-2734
    CrossrefPubMedGoogle Scholar
  • 25 Angara P, Tsang DC, Hoffer ME, Snapp HA. Self-perceived hearing status creates an unrealized barrier to hearing healthcare utilization. Laryngoscope 2021; 131 (01) E289-E295
    CrossrefPubMedGoogle Scholar
  • 26 Dornhoffer JR, Holcomb MA, Meyer TA, Dubno JR, McRackan TR. Factors influencing time to cochlear implantation. Otol Neurotol 2020; 41 (02) 173-177
    CrossrefPubMedGoogle Scholar
  • 27 Tolisano AM, Fang LB, Kutz Jr JW, Isaacson B, Hunter JB. Better defining best-aided condition: the role of hearing aids on cochlear implantation qualification rates. Am J Otolaryngol 2020; 41 (03) 102431
    CrossrefPubMedGoogle Scholar
  • 28 Krist AH, Davidson KW, Mangione CM. et al; US Preventive Services Task Force. Screening for hearing loss in older adults: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325 (12) 1196-1201
    CrossrefPubMedGoogle Scholar
  • 29 Sorkin DL. Cochlear implantation in the world's largest medical device market: utilization and awareness of cochlear implants in the United States. Cochlear Implants Int 2013; 14 (Suppl. 01) S4-S12
    CrossrefPubMedGoogle Scholar
  • 30 Bogardus Jr ST, Yueh B, Shekelle PG. Screening and management of adult hearing loss in primary care: clinical applications. JAMA 2003; 289 (15) 1986-1990
    CrossrefPubMedGoogle Scholar
  • 31 Sullivan F. Barriers in the ENT referral channel to the adoption of CI as a standard of care for severe to profound hearing loss patients. In: US Medical Devices Market Outlook. Published 2008. Accessed October 20, 2021 at: www.frost.com
    PubMedGoogle Scholar
  • 32 Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care: scientific review. JAMA 2003; 289 (15) 1976-1985
    CrossrefPubMedGoogle Scholar
  • 33 Bright T, Pallawela D. Validated smartphone-based apps for ear and hearing assessments: a review. JMIR Rehabil Assist Technol 2016; 3 (02) e13
    CrossrefPubMedGoogle Scholar
  • 34 Klyn NAM, Letendre C, Shrestha N, Lambert BL, Dhar S. Interpretability of the audiogram by audiologists and physician non-specialists. Int J Audiol 2021; 60 (02) 133-139
    CrossrefPubMedGoogle Scholar
  • 35 Looi V, Bluett C, Boisvert I. Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment. Int J Audiol 2017; 56 (12) 919-925
    CrossrefPubMedGoogle Scholar
  • 36 Arnoldner C, Lin VY. Expanded selection criteria in adult cochlear implantation. Cochlear Implants Int 2013; 14 (Suppl. 04) S10-S13
    CrossrefPubMedGoogle Scholar
  • 37 Carlson ML, Sladen DP, Gurgel RK, Tombers NM, Lohse CM, Driscoll CL. Survey of the American Neurotology Society on Cochlear Implantation: Part 1, Candidacy assessment and expanding indications. Otol Neurotol 2018; 39 (01) e12-e19
    CrossrefPubMedGoogle Scholar
  • 38 Huinck WJ, Mylanus EAM, Snik AFM. Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss. Eur Arch Otorhinolaryngol 2019; 276 (05) 1313-1320
    CrossrefPubMedGoogle Scholar
  • 39 Huart S. Unidentified and underserved: cochlear implant candidates in the hearing aid dispensing practice. Audiology Online. 2009
    Google Scholar
  • 40 Hunter JB, Tolisano AM. When to refer a hearing-impaired patient for a cochlear implant evaluation. Otol Neurotol 2021; 42 (05) e530-e535
    CrossrefPubMedGoogle Scholar
  • 41 Gubbels SP, Gartrell BC, Ploch JL, Hanson KD. Can routine office-based audiometry predict cochlear implant evaluation results?. Laryngoscope 2017; 127 (01) 216-222
    CrossrefPubMedGoogle Scholar
  • 42 Zwolan TA, Schvartz-Leyzac KC, Pleasant T. Development of a 60/60 guideline for referring adults for a traditional cochlear implant candidacy evaluation. Otol Neurotol 2020; 41 (07) 895-900
    CrossrefPubMedGoogle Scholar
  • 43 McRackan TR, Fabie JE, Burton JA, Munawar S, Holcomb MA, Dubno JR. Earphone and aided word recognition differences in cochlear implant candidates. Otol Neurotol 2018; 39 (07) e543-e549
    CrossrefPubMedGoogle Scholar
  • 44 Leigh JR, Moran M, Hollow R, Dowell RC. Evidence-based guidelines for recommending cochlear implantation for postlingually deafened adults. Int J Audiol 2016; 55 (Suppl. 02) S3-S8
    CrossrefPubMedGoogle Scholar
  • 45 Sydlowski SA, Weaver RE. Relationship between unaided word recognition scores and cochlear implant candidacy. American Cochlear Implant Alliance. 2021. ; Virtual Poster Presentation
    Google Scholar
  • 46 Moses LE, Friedmann DR. Cochlear implant indications: a review of third-party payers' policies for standard and expanded indications. Cochlear Implants Int 2021; 22 (04) 237-244
    CrossrefPubMedGoogle Scholar
  • 47 Hogan A, Taylor A, Westcott S. Audiologists' attitudes to cochlear implants. Cochlear Implants Int 2001; 2 (01) 17-29
    CrossrefPubMedGoogle Scholar
  • 48 Hixon B, Chan S, Adkins M, Shinn JB, Bush ML. Timing and impact of hearing healthcare in adult cochlear implant recipients: a rural-urban comparison. Otol Neurotol 2016; 37 (09) 1320-1324
    CrossrefPubMedGoogle Scholar
  • 49 Noblitt B, Alfonso KP, Adkins M, Bush ML. Barriers to rehabilitation care in pediatric cochlear implant recipients. Otol Neurotol 2018; 39 (05) e307-e313
    CrossrefPubMedGoogle Scholar
  • 50 Prentiss S, Snapp H, Zwolan T. Audiology practices in the preoperative evaluation and management of adult cochlear implant candidates. JAMA Otolaryngol Head Neck Surg 2020; 146 (02) 136-142
    CrossrefPubMedGoogle Scholar
  • 51 Dunn C, Miller SE, Schafer EC, Silva C, Gifford RH, Grisel JJ. Benefits of a hearing registry: cochlear implant candidacy in quiet versus noise in 1,611 patients. Am J Audiol 2020; 29 (04) 851-861
    CrossrefPubMedGoogle Scholar
  • 52 Athalye S, Mulla I, Archbold S. The experiences of adults assessed for cochlear implantation who did not proceed. Cochlear Implants Int 2014; 15 (06) 301-311
    CrossrefPubMedGoogle Scholar
  • 53 Buchman CA, Gifford RH, Haynes DS. et al. Unilateral cochlear implants for severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss: a systematic review and consensus statements. JAMA Otolaryngol Head Neck Surg 2020; 146 (10) 942-953
    CrossrefPubMedGoogle Scholar
  • 54 Carlson ML, O'Connell BP, Lohse CM, Driscoll CL, Sweeney AD. Survey of the American Neurotology Society on Cochlear Implantation: Part 2, Surgical and device-related practice patterns. Otol Neurotol 2018; 39 (01) e20-e27
    CrossrefPubMedGoogle Scholar
  • 55 Decision Memo for cochlear implantation (CAG-00107N). Centers for Medicare & Medicaid Services. 2005 . Accessed May 1, 2021
    PubMedGoogle Scholar
  • 56 Zwolan TA, Kallogjeri D, Firszt JB, Buchman CA. Assessment of cochlear implants for adult Medicare beneficiaries aged 65 years or older who meet expanded indications of open-set sentence recognition: a multicenter nonrandomized clinical trial. JAMA Otolaryngol Head Neck Surg 2020; 146 (10) 933-941
    CrossrefPubMedGoogle Scholar
  • 57 Miller SE, Anderson C, Manning J, Schafer E. Insurance payer status predicts postoperative speech outcomes in adult cochlear implant recipients. J Am Acad Audiol 2020; 31 (09) 666-673
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med 2011; 171 (20) 1851-1852
    CrossrefPubMedGoogle Scholar
  • 59 Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hearing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci 2011; 66 (05) 582-590
    CrossrefPubMedGoogle Scholar
  • 60 Choi JS, Briggs SE. Health disparities in geriatric cochlear implantation. Am Acad Otolaryngol Head Neck Surg Bull. 2020; 39
    PubMedGoogle Scholar
  • 61 Issing C, Baumann U, Pantel J, Stöver T. Cochlear implant therapy improves the quality of life in older patients - a prospective evaluation study. Otol Neurotol 2020; 41 (09) 1214-1221
    CrossrefPubMedGoogle Scholar
  • 62 Issing C, Baumann U, Pantel J, Stöver T. Impact of hearing rehabilitation using cochlear implants on cognitive function in older patients. Otol Neurotol 2021; 42 (08) 1136-1141
    CrossrefPubMedGoogle Scholar
  • 63 Lally JW, Adams JK, Wilkerson BJ. The use of cochlear implantation in the elderly. Curr Opin Otolaryngol Head Neck Surg 2019; 27 (05) 387-391
    CrossrefPubMedGoogle Scholar
  • 64 Marder D. Sound of Metal [Film]. Amazon Studios. 2020
    PubMedGoogle Scholar
  • 65 Cooley J. Toy Story 4 [Film]. Walt Disney Studios. 2019
    PubMedGoogle Scholar
  • 66 First Call With My Son - Matthew's True Pixel Story. YouTube.com. 2021
    PubMedGoogle Scholar
  • 67 Wallhagen MI. The stigma of hearing loss. Gerontologist 2010; 50 (01) 66-75
    CrossrefPubMedGoogle Scholar
  • 68 Laplante-Lévesque A, Hickson L, Worrall L. Factors influencing rehabilitation decisions of adults with acquired hearing impairment. Int J Audiol 2010; 49 (07) 497-507
    CrossrefPubMedGoogle Scholar
  • 69 Bierbaum M, McMahon CM, Hughes S. et al. Barriers and facilitators to cochlear implant uptake in Australia and the United Kingdom. Ear Hear 2020; 41 (02) 374-385
    CrossrefPubMedGoogle Scholar
  • 70 Kassirer S, Levine EE, Gaertig C. Decisional autonomy undermines advisees' judgments of experts in medicine and in life. Proc Natl Acad Sci U S A 2020; 117 (21) 11368-11378
    CrossrefPubMedGoogle Scholar
  • 71 Bush ML, Thompson R, Irungu C, Ayugi J. The role of telemedicine in auditory rehabilitation: a systematic review. Otol Neurotol 2016; 37 (10) 1466-1474
    CrossrefPubMedGoogle Scholar
  • 72 Meeuws M, Pascoal D, Janssens de Varebeke S, De Ceulaer G, Govaerts PJ. Cochlear implant telemedicine: remote fitting based on psychoacoustic self-tests and artificial intelligence. Cochlear Implants Int 2020; 21 (05) 260-268
    CrossrefPubMedGoogle Scholar
  • 73 Kuzovkov V, Yanov Y, Levin S. et al. Remote programming of MED-EL cochlear implants: users' and professionals' evaluation of the remote programming experience. Acta Otolaryngol 2014; 134 (07) 709-716
    CrossrefPubMedGoogle Scholar
  • 74 Luryi AL, Tower JI, Preston J, Burkland A, Trueheart CE, Hildrew DM. Cochlear implant mapping through telemedicine - a feasibility study. Otol Neurotol 2020; 41 (03) e330-e333
    CrossrefPubMedGoogle Scholar
  • 75 Slager HK, Jensen J, Kozlowski K. et al. Remote programming of cochlear implants. Otol Neurotol 2019; 40 (03) e260-e266
    CrossrefPubMedGoogle Scholar
  • 76 Shayman CS, Ha YM, Raz Y, Hullar TE. Geographic disparities in US Veterans' access to cochlear implant care within the Veterans Health Administration System. JAMA Otolaryngol Head Neck Surg 2019; 145 (10) 889-896
    CrossrefPubMedGoogle Scholar
  • 77 Garber S, Ridgely MS, Bradley M, Chin KW. Payment under public and private insurance and access to cochlear implants. Arch Otolaryngol Head Neck Surg 2002; 128 (10) 1145-1152
    CrossrefPubMedGoogle Scholar
  • 78 Kim J, Jeon S, Kim D, Shin Y. A review of contemporary teleaudiology: literature review, technology, and considerations for practicing. J Audiol Otol 2021; 25 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 79 Bhutta MF, Swanepoel W, Fagan J. ENT from afar: opportunities for remote patient assessment, clinical management, teaching and learning. Clin Otolaryngol 2021; 46 (04) 689-691
    CrossrefPubMedGoogle Scholar