Cochlear Implant Programming: A Global Survey on the State of the Art

Abstract

The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice.

Cochlear Implant – State of the Art

“…In order to control the usage by means of a so-called datalogging, the implant registers several parameters such as the daily time of usage. This information can be used to support rehabilitation [52]. …”

Variables that Effect Psychophysical Parameters and Duration to Stability in Cochlear Implant Mapping

“…Most cochlear implant centers apply a "one size fits all approach" to the mapping process [5]. This leads to a failure to identify, and potentially address, outliers until they are failing to stabilize within the usual time.…”

“…Most centers rely mainly on the patient's subjective feedback as a basis for the mapping changes, which is interesting considering most clinicians do not believe the patient's subjective experience leads to optimal cochlear implant performance [5]. In a global survey of cochlear implant center mapping practices, it was found that the average center schedules three sessions in the first three months, three sessions in the following nine months, and another one annual session thereafter [5].…”

“…In a global survey of cochlear implant center mapping practices, it was found that the average center schedules three sessions in the first three months, three sessions in the following nine months, and another one annual session thereafter [5]. The majority of time, in these appointments, is spent with verification and adjustments to optimize loudness.…”

“…Psychophysical parameters are measured for each portion of the cochlear implant electrode array (the basal, medial and apical regions). This mapping stage is known to be a period of high variability in audiological responses, and requires close follow up by an audiologist with an average of 6 visits in the first year, with some institutions advocating for up to ten [3][4][5].…”