Source: MIL-OSI Submissions
Source: Katie Moore
· World-first consensus paper published today in Jama Otolaryngology recommends ‘minimum international standard of care for cochlear implantation’, including diagnosis, referral, treatment and aftercare for adults living with severe to profound sensorineural hearing loss1
· Associate Professor of Audiology at the University of Auckland, Holly Teagle was part of a global panel of 31 ear nose and throat surgeons and audiologists, and seven hearing organisations, calling for improved standards in adult hearing care.
· The paper provides reason for optimism for thousands of New Zealand adults living with severe to profound hearing loss7 and clear guidance for hearing health professionals1
The first ever global consensus on the use of cochlear implants for the management of adults living with hearing loss was published today in Jama Otolaryngology.1
The paper was authored by a new panel, including 31 hearing experts from surgical and audiology backgrounds representing more than 13 countries. The authors also consulted representatives from worldwide patient and professional societies.1
According to Associate Professor Holly Teagle, and co-author of the consensus paper/member of the International Cochlear Implant Advocacy Alliance, the publication is a major step forward in the treatment of hearing loss in New Zealand.
“This consensus document will help create clinical best practice guidelines that will lead to a standard of care which is currently lacking for adults living with a severe hearing disability. In New Zealand, while we are performing well against many of the statements in the document, due to our limited funding resources for adults, we are not implanting adults in a timely manner which is impacting their quality of life and hearing outcomes.”
Auckland teacher, Mark Newman, met the clinical criteria as set out in the consensus document for a cochlear implant, but due to the strict funding criteria in New Zealand, was unable to access a publically funded implant.
“I started losing my hearing 21 years ago, and in 2017 I was referred to the cochlear implant programme. Although I clinically met the criteria for an implant, due to the funding restrictions I was advised that it was unlikely that I would get a publically funded one.
“I was terrified I would lose my job, so I decided I would fundraise for one through Facebook and Givealittle, and got my first implant in December 2017. Two years later, I took out a loan through GEM finance for my second one. If I had not funded my implants I would have lost my career. I’d already lost my social life and enjoyment of music, I wasn’t prepared to lose anymore.”
According to Lee Schoushkoff, CEO of the Northern Cochlear Implant Trust, and Neil Heslop, CEO of the Southern Cochlear Implant Programme, the consensus paper is a major landmark in the treatment of severe to profound hearing loss, but New Zealand still has a long way to go in this regard.
In New Zealand, just 40 adults nationally receive government funding for a cochlear implant every year. Today, there are 230 people on the waiting list, and every year this number is expected to increase by 40 to 50 people.
“Before now, there has never been an international agreement on the best way to diagnose and treat severe to profound hearing loss in adults. This paper outlines the first ever-global consensus on how we can optimise hearing care for adults,” says Schoushkoff.
Heslop adds, “Without an increase in government funding for adult cochlear implants, hundreds of New Zealanders face the prospect of never hearing again. Cochlear implants are not covered by health insurance; either you are one of the 20 percent lucky enough to be funded, or you pay $50,000 to have the procedure privately. Our funding is also significantly out of step with other OECD countries.”
Though cochlear implants are an effective medical intervention for many adults living with severe to profound sensorineural hearing loss3, conservative estimates suggest that no more than 1 in 20 adults who could benefit from a cochlear implant have one.4,5
To view the consensus paper, including the full methodology and consensus statements, click here www.adulthearing.com
About the consensus process1
The consensus process began with a systematic literature review to identify relevant studies in the subject area. These were used to inform the development of evidence-based draft consensus statements. The draft statements then entered the Delphi voting process, which involved three anonymous voting rounds.
All members of the steering committee and the Delphi consensus panel, except the Chair, were able to vote as part of the Delphi process. Voting on the draft consensus statements took place over three rounds. Consensus was defined as agreement by a least 75 percent of respondents. During this process, all panel members had access to a report of the evidence from a systematic literature review, including the results of the quality assessment of included studies.
The consensus paper includes 20 statements covering seven categories for adults with severe, profound, or moderate sloping to profound hearing loss in both ears. The panel members, following consultation with a Consumer and Professional Advocacy Committee (CAPAC) agreed upon each statement. Categories include:
· Level of awareness of cochlear implants
· Best practice clinical pathway for diagnosis
· Best practice guidelines for surgery
· Clinical effectiveness of cochlear implants
· Factors associated with post-implantation outcomes
· The relationship between hearing loss and depression, cognition and dementia
· Cost implications of cochlear implants.
About the authors
The Delphi consensus process on unilateral cochlear implantation in adults with bilateral severe, profound, or moderate sloping to profound sensorineural hearing loss was guided by a non-voting Chair, Dr Craig Buchman, Head of Otolaryngology – Head & Neck Surgery, Washington University School of Medicine, St Louis, U.S. The Chair was supported by four steering committee members who were able to vote: Professor René Gifford, Vanderbilt University, Nashville, U.S.; Dr David Haynes, Vanderbilt University, Nashville, U.S.; Professor Thomas Lenarz, Medical University of Hannover, Germany and Professor Gerard O’Donoghue, University of Nottingham, UK.
The voting members of the Delphi panel also included 26 experts in the field of cochlear implant use, including audiologists and ear, nose and throat specialists from across 13 countries.
In addition, a Consumer and Professional Advocacy Committee (CAPAC) of international cochlear implant user and professional advocacy organisations was involved in the development of the consensus statements.
*Hearing loss severe enough to have great difficulty hearing and taking part in conversations in noisy environments.
The Delphi process and medical writing have received funding support from Advanced Bionics, Cochlear Ltd, Med-El and Oticon Medical. The funding organizations did not contribute to the design, facilitation or content of the Delphi consensus process.
1. Buchman CA et al. Unilateral Cochlear Implants for Bilateral Severe, Profound, or Moderate Sloping to Profound Sensorineural Hearing Loss. JAMA Otolaryngology 2020. Epub ahead of Print.
2. Cohen SM, Labadie RF, and Haynes DS. Primary care approach to hearing loss: the hidden disability. Ear Nose Throat J 2005;84:26.
3. Raine C, Atkinson H, Strachan DR, et al. Access to cochlear implants: Time to reflect. Cochlear Implants Int 2016;17 (Suppl 1):42–6.
4. Gaylor JM, Raman G, Chung M, et al. JAMA Otolaryngology Head Neck Surg. 2013;139(3):265-272.
5. Sorkin D. 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):S1.
6. De Raeve L. Cochlear implants in Belgium: Prevalence in paediatric and adult cochlear implantation. Eur Ann Otorhinolaryngol Head Neck Dis 2016;133(Suppl 1):S57–60.
7. National Foundation for the Deaf (2017); Listen Hear Report, Auckland.