American Cochlear Implant Alliance held its 2nd Emerging Issues in Cochlear Implantation Conference on October 15-17th in Washington DC, at the Omni Shoreham Hotel.
Click HERE for a full copy of the conference program.
To view session materials from the Plenary and Special Sessions please click HERE.
To view session materials from the Concurrent Sessions please click HERE.
To view our CI2015 Photo Gallery please click HERE.
Six emerging issues were the focus of CI2015:
1. Auditory Brainstem Implants in Children
In 2015, four US cochlear implant centers had FDA approved Investigational Device Exemptions (IDE) protocols for the implantation of children with deficient or absent cochleae or cochlear nerve deficiency. Approximately 20 US children had been implanted at that time under IDEs. Among the key considerations for ABI use in children are the candidacy evaluation, audiological management, provision of a cochlear implant before ABI (to aide/confirm decision-making), surgical placement and complications, and expected speech and language development benefits. Objective measures and outcomes of ABI in children have been utilized to inform the decision-making in the provision of the ABI device.
2. Expanded Indications for Cochlear Implantation
Traditional cochlear implant candidates have bilateral moderate to profound hearing loss and may receive a cochlear implant in one or both ears. In cases of unilateral implantation, the recipient may utilize a hearing aid on the non-implanted ear. The necessity of bilateral input for binaural processing is well documented. There is consideration of whether the current cochlear implant indications in adults and children should be expanded to those with less severe hearing loss in the non-implanted ear or even normal to near-normal hearing in the non-implanted ear. Among the Issues to be considered are the specific candidacy, test measures, current results, and demographic variables that may affect performance, expectations, and patient report with expanded indications.
3. Literacy and Cochlear Implantation: Outcomes and Intervention Strategies
The advent of cochlear implantation as a treatment for prelingual profound deafness in children is associated with a reduction in the well-documented achievement gap relative to age-mates with normal hearing. The development of literacy for a deaf child from preschool to adolescence is affected markedly by cochlear implantation. Also of importance is the child’s access to an intervention process that is designed to capitalize on functional hearing and facilitate early development of decoding and meaning-based skills. Improvements in literacy are significantly associated with younger implantation ages and newer technologies though there are still gaps in our knowledge regarding the best ways to achieve a positive literacy outcome for a deaf child.
4. Objective Measures for Cochlear Implantation
Peripheral measures of auditory nerve function with a cochlear implant allow us objectively assess how the auditory system responds to stimulation from a cochlear implant. Such assessments include the effects of stimulus polarity on measurements of the electrically evoked compound action potential (ECAP), the relationship between evoked potentials and CT imaging, and findings on both ECAP and cortical auditory evoked potentials in children with cochlear implants and auditory neuropathy spectrum disorder. Recent research has expanded knowledge of how objective measures can be used to provide information about auditory pathway function in cochlear implant recipients that can contribute positively to clinician care practices.
5. Quality of Life and Cost-Effectiveness of Cochlear Implantation
Our present era of health care reform has brought increased scrutiny and pressure on the medical profession to provide both effective and cost-effective care. For the past 20 years, there has been a growing emphasis on evidence of effectiveness and cost-effectiveness in guiding policy decisions that direct reimbursement and the prioritization of health resources (Eddy, JAMA,1996). As an estimated 30% of the recent increase in health care costs can be traced to advances in medical technology, we must continue to ask ourselves: "Is the cochlear implant worth the price?” Further, in the US, cochlear implant candidates often endure a lengthy, challenging process in order to obtain third-party payment for their device, surgery and postoperative (re)habilitation. In many cases, reimbursement is significantly below the cost incurred by programs of support. Such challenges to patient access and sustained programmatic support require research data that evaluate the related medical economics, rating the effectiveness of interventions in an effort to optimize the use of health care dollars. In examining the cost-effectiveness of cochlear implants, it is important not only to compare them with other medical interventions, but also to consider the implications and costs of untreated or under treated sensorineural hearing loss. An assessment of research related to quality of life changes and cost effectiveness associated with cochlear implantation across various medical interventions as well as national settings around the world provides important insights regarding the quality of life changes and cost effectiveness associated with cochlear implantation.
6. Cochlear Implant Connectivity to Other Technologies
Evidence-based strategies for expanding outcomes of individuals with cochlear implants through the use of cell phone and remote-microphone assistive-technology applications provide important opportunities for recipients. Current Federal Communications Commission (FCC) regulations govern cell phone compatibility with hearing aids including a requirement that cell phone manufacturers test and "rate” interference relative to cell phone linkage with hearing aids. It is believed (though research based assessments are lacking) that these same regulations and rating schemes are relevant to users of cochlear implants. Research supports the benefit of various cell phone-connectivity options such as direct audio input, Bluetooth, and telecoil. There is also evidence to support the efficacy and effectiveness of remote-microphone, hearing-assistance technologies including frequency modulation (FM) and digital transmission systems for both adults and children with cochlear implants. At the same, research demonstrates that there are benefits as well as pitfalls for technologies in terms of ease of use, benefit in various settings, sound clarity, speech recognition, reliability, and cost.