H. Jeffrey Kim, MD
Georgetown MedStar Health
CI2015DC Emerging Issues in Cochlear Implantation
This section covers the following topics:
- Advances in Candidacy, Technology and Outcomes
- Adult Candidacy Guidance
- Position Paper: Pediatric Habilitation Following Cochlear Implantation
- Bilateral Cochlear Implantation
- Revised Recommendation for Pneumococcal Meningitis Vaccination for Implant Recipients
- Recommendations for Adults for Obtaining the Meningitis Vaccine
Advances in Candidacy, Technology, and Outcomes
Cochlear Implants 2016: Advances in Candidacy, Technology, and Outcomes, Factors That Drive the Expansion of Pediatric Cochlear Implant Candidacy by Terry Zwolan and Donna Sorkin was published by ASHA’s Special Interest Group on Hearing and Hearing Disorders in Childhood, SIG 9, Vol. 1(Part 1), 2016. It reviews recent progress made in cochlear implant technology, effects of early intervention, better understanding of the impact of residual hearing, and resultant changes in pediatric candidacy criteria and outcomes.
This is intended as a helpful paper to share with non-CI clinicians, early intervention personnel, educators, pediatricians, parents and others who interact with families of children with hearing loss.
Contact Susan Thomas (firstname.lastname@example.org) if you would like to receive a copy of this paper.
Adult Cochlear Implant Candidacy Guidance
Hearing aids provide important benefit for the majority of people with hearing loss. Cochlear implants provide meaningful access to sound for those with more severe hearing loss. Only 5% of US adults who could benefit from cochlear implants have them. The average primary care medical practice
includes 8 adult patients who would benefit from a cochlear implant.
- Adults who could benefit from CIs typically do not know they are candidates nor what the expected outcomes are
- Age is not a contraindication for CI in otherwise healthy people
- Hearing loss is often progressive
- Hearing acuity declines may be due to noise exposure, genetics, disease, trauma, or ototoxic medications
ACI Alliance offers two Clinical Guidance papers on Adult Candidacy:
ACI Alliance Issues Pediatric Habilitation Position Paper
American Cochlear Implant Alliance advocates for access to the continuum of cochlear implant care, which includes (re)habilitation needed for a child or an adult. Our State Champions assessed coverage of cochlear implantation under Affordable Care Act Marketplace plans. We found that CI was a covered service in nearly every plan we looked at. However, we had concerns relating to limitations on the number of therapy sessions allowed under such plans, which typically were limited to 30 sessions per year—regardless of the age of the patient. Such limits are often referred to as "therapy caps” and are increasingly common in private insurance plans.
The Board of Directors of ACI Alliance appointed a committee of therapeutic clinicians to develop a position paper on pediatric habilitation following cochlear implantation. The committee was encouraged to utilize an evidence-based approach and provide a document that would be helpful in documenting the need for appropriate habilitation post cochlear implantation. The attached Position Paper was authored by Hannah Eskridge, Amy McConkey Robbins, Kathryn Wilson, and Lindsay Zombek and approved by the ACI Alliance Board of Directors. We are grateful to the committee for this significant contribution to our field. Position Paper: Pediatric Habilitation Following Cochlear Implantation.
How to Use the Position Paper
We intend for this paper to be utilized as a resource for health insurance providers (both public and private plans), early intervention professionals, families, pediatricians, and others involved in ensuring appropriate speech-language services for children with hearing loss. It may also be helpful to reference the Cochlear Implant Continuum of Care, available on our website under Cochlear Implant Information. We welcome your feedback on the Position Paper and your ideas for other position statements that may improve access to cochlear implant care.
Bilateral Cochlear Implantation
American Cochlear Implant Alliance Posts comments for Washington State Technology Assessment of Bilateral Cochlear Implants.
The ACI Alliance and others in the cochlear implant community participated in the Washington State Health Technology Assessment, a process to determine if and how the state would cover bilateral cochlear implants under state sponsored programs such as Medicaid. John Niparko, MD, Past Chair of the ACI Alliance Board of Directors, provided oral testimony at the Clinical Committee Meeting on May 17, 2014. To view comments click HERE.
Position Statement on Bilateral Cochlear Implantation:
To read more about ACI Alliance's Advocacy activities visit our Advocacy Page.
Revised Recommendation for Pneumococcal Meningitis Vaccination for Implant Recipients
The Centers For Disease Control has revised the recommendation for pneumococcal meningitis vaccination for adults and for children who are cochlear implant recipients or candidates. These recommendations were revised after recent studies on vaccine effectiveness in immunocompetent patients indicated that a change to the vaccine regimen may prove to be even more effective in preventing meningitis in these groups.
Resources on the Meningitis Vaccination
Pneumococcal Meningitis Vaccination for Adult Cochlear Implant Candidates or Recipients
The Centers for Disease Control (CDC) recommends the pneumococcal meningitis vaccination for adult cochlear implant candidates and recipients. The Centers for Disease Control’s initial recommendation for inoculation applied to children only. Upon further research, the CDC revised their recommendation for pneumococcal meningitis vaccination to include adult cochlear implant recipients as well as children.
These recommendations are based on Food and Drug (FDA) studies of vaccine effectiveness in immunocompetent patients that indicate the vaccine regimen has been proven to be effective in preventing meningitis in cochlear implant recipients. For more information visit: http://www.immunize.org/catg.d/p2015.pdf or https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e731a1.htm
Adult access to pneumococcal meningitis vaccine
ACI Alliance received notice that some adult candidates were being denied the Prevnar 13 vaccine (one of the vaccines for pneumococcal meningitis) prior to their cochlear implant surgery if they were younger than the vaccine’s typically recommended age category of 65 years.
To explore whether this was widespread, we made a number of telephone calls to ask about availability “for a relative.” Based on our research, which covered three different states, we found no incidences in which an individual would have been refused access to the vaccine (even if they were under age 65). The pharmacy chains we contacted—CVS, Walgreens, Rite Aid, Safeway, and Giant Foods (the latter being a DC area grocery chain with pharmacy services), all confirmed that the vaccine was reliably available for cochlear implant candidates and recipients.
Considering the feedback from a number of pharmacists that we spoke to, we recommend that individuals bring a prescription from their physician to the pharmacy when seeking the Prevnar 13 vaccination. In addition, we recommend that individuals contact their insurance company prior to receiving the vaccination confirming coverage benefits. Additional documentation from the physician may be required for coverage.
In summary, we are pleased to confirm availability of the pneumococcal meningitis vaccination for adult cochlear implant candidates and recipients. If you or a family member encounters difficulty in obtaining the vaccine from a local pharmacy, we recommend having the pharmacy contact the cochlear implant physician. In addition, you can provide the pharmacy with the CDC recommendations available at the website above.
Click HERE to print.
Additional Resources on the Meningitis Vaccine:
The Center for Disease Control provides Q &A for Health Care Professionals: Persons with cochlear implants should be considered high-risk for pneumococcal meningitis. To help prevent meningitis for this group, consider the questions listed HERE.
CDC Position Statement: Immunizations Recommendations for Cochlear Implant Patients: Guidelines provided by the Centers for Disease Control and Prevention (CDC) recommending the importance of age-appropriate immunizations against specific organisms that cause meningitis in patients who have, or will receive a cochlear implant.
The Importance of Vaccinations in Cochlear Implant Users: The Children's Cochlear Implant Center at UNC School of Medicine provides information regarding the two types of pneumococcal vaccine and the immunization schedules for children.