Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition

Abstract

IMPORTANCE Current indications for Medicare beneficiaries to receive a cochlear implant are outdated. Multichannel cochlear implant systems may be effective when provided to Medicare beneficiaries using expanded indications.OBJECTIVE To examine the effectiveness of cochlear implants, as measured by improvement on the AzBio Sentence Test, for newly implanted Medicare beneficiaries who meet the expanded indications of an AzBio Sentence Test score of 41% to 60% in their best-aided condition. DESIGN, SETTING, AND PARTICIPANTSA multicenter nonrandomized trial examined preoperative and postoperative speech recognition, telephone communication, hearing device benefit, health utility, and quality of life for 34 participants enrolled at 8 different centers who received a cochlear implant between September 17, 2014, and July 10, 2018. All participants were 65 years or older, had bilateral moderate to profound hearing loss, and had a best-aided preoperative AzBio Sentence Test score in quiet of 41% to 60%. Analysis was performed on an intention-to-treat basis. Statistical analysis of final results took place from July 29 to October 1, 2019.INTERVENTION Multichannel cochlear implants. MAIN OUTCOMES AND MEASURESThe study examined the a priori hypothesis that the cochlear implant would improve the AzBio Sentence Test score in the best-aided condition by 25% or more and in the implanted ear-alone condition by 30% or more. The study additionally examined word and telephone recognition and examined device benefit, health utility, and quality of life.RESULTS A total of 34 participants received a cochlear implant; 31 (23 men [74%]; median age, 73.6 years [range, 65.7-85.1 years]) completed testing through the 6-month evaluation, and 29 completed testing through the 12-month evaluation. Median preoperative AzBio Sentence Test scores were 53% (range, 26%-60%) for the best-aided condition and 24% (range, 0%-53%) for the cochlear implant-alone condition; median scores 12 months after implantation improved to 89% (range, 36%-100%) for the best-aided condition and 77% (range, 13%-100%) for the cochlear implant-alone condition. This outcome represents a median change of 36% (range, -22% to 75%) for the best-aided condition (lower bound of 1-sided 95% CI, 31%) and a median change of 53% (range, -15% to 93%) for the cochlear implant-alone condition (lower bound of 1-sided 95% CI, 45%). CONCLUSIONS AND RELEVANCEIntervention with a cochlear implant was associated with improved sentence, word, and telephone recognition in adult Medicare beneficiaries whose preoperative AzBio Sentence Test scores were between 41% and 60%. These findings support expansion of the Center for Medicare & Medicaid current indications for cochlear implants.

The Effectiveness of Unilateral Cochlear Implantation on Performance-Based and Patient-Reported Outcome Measures in Finnish Recipients

“…When SiN is measured with a presentation level of +10 dB SNR, the level of the speech signal is so much higher than the noise level that this test condition can be likened to speech perception in quiet. With this in mind, the improvement in SiN scores measured at a constant SNR (+10 dB SNR) fits well with previous results that have shown robust improvements in speech perception in quiet after implantation ( Mudery et al, 2017 ; Zwolan et al, 2020 ). The improvement we found for SRTN demonstrates that cochlear implantation is also effective in improving patients’ speech perception in complex listening environments.…”

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

“…55 These stringent requirements have meaningful implications, and can preclude CI in patients with considerable hearing impairment experiencing limited benefit from hearing amplification who do not meet the above criteria. 56 In cases of asymmetric hearing loss with a better hearing ear that does not meet Medicare stipulations, patients experience a delay in treatment for the qualifying ear as they wait for deterioration of the better hearing ear to ultimately meet bilateral, best-aided Medicare criteria, leading to unnecessary prolonged duration of deafness in the poorer hearing ear. 18 57 As most adults aged more than 64 in the United States constitute the Medicare beneficiary population, unique bilateral criteria which restrict access to care and cause treatment delay do so in the population most vulnerable to significant hearing loss.…”

Comparing the Speech Perception of Cochlear Implant Users with Three Different Finnish Speech Intelligibility Tests in Noise

“…CIs are safe and effective intervention for HL [1][2][3][4], even in elderly patients [5]. Reaching open-set speech perception is currently a realistic and attainable goal for the majority of CI users [6][7][8]. However, while CIs provide most patients adequate speech perception in quiet listening conditions, speech perception typically deteriorates drastically in noise [6,9], and noisy listening environments remain a challenge for CI users.…”