Effect of a Global Pandemic on Adult and Pediatric Cochlear Implantation across the United States

Abstract

ObjectiveTo characterize the effect of the COVID-19 pandemic on national cochlear implantation utilization by age using inclusive cochlear implantation data from two manufacturers between 2015 and 2020.Study DesignAnalysis of prospectively registered consecutive patient data from two major cochlear implant (CI) manufacturers in the United States.PatientsChildren or adults who received CIs.InterventionsCochlear implantation.Main Outcome MeasuresAnnual implantation utilization by age.ResultsA total of 46,804 patients received CIs from the two participating manufacturers between 2015 and 2020. The annual number of implant recipients increased significantly during the first 5 years of the study period for both children and adults, from a total of 6,203 in 2015 to 9,213 in 2019 (p < 0.001). During 2020, there was a 13.1% drop in national cochlear implantation utilization across all ages compared with 2019, including a drop of 2.2% for those ≤3 years old, 3.8% for those 4–17 years old, 10.1% for those 18–64 years old, 16.6% for those 65–79 years old, and 22.5% for those ≥80 years old. In a multivariable linear regression model, the percent drop in CIs differed significantly by age-group (p = 0.005).ConclusionsEspecially in light of the prepandemic projected CI counts for 2020, the COVID-19 pandemic reduced national cochlear implantation utilization by over 15% among Medicare-aged patients and by almost 25% among those ≥80 years old, resulting in more than a 3-year setback in total annual CIs. Children were less affected, with those ≤3 years old experiencing minimal interruption during 2020.

National Trends in Cochlear Implantation Across the Department of the Defense: A Case for Inclusion as a General Otolaryngology Core Competency

“…Nassiri et al (4) reported a 43% increase in CI procedures at high-volume cochlear implant centers from 2015 to 2020. In the largest cohort to date, data from two CI manufacturers reported a similar increase from 2015 to 2019 of 49% (9). Although previous studies have provided rates of change over an entire study period, we additionally report an AAGR.…”

“…Active-duty service members are preferentially treated at military treatment facilities, although this population rarely receives cochlear implants and we do not believe this difference in populations to be an important factor. In addition, this study includes the years before the COVID-19 pandemic, and this likely influenced CI trends (9). Future work in this area looks to project changing practice trends within otology, identify and limit barriers to implantation, specifically as they relate to the general otolaryngologist.…”

Seven-Year Revision Rates for Cochlear Implants in Pediatric and Adult Populations of an Integrated Healthcare System

“…Durability is important particularly in the extremes of the age spectrum. The recall also came at a particularly unfortunate time where a global pandemic strained the health care system and resulted in an average 13% drop in implant utilization, worse in patients older than 80 years (21). Octogenarians are particularly vulnerable because of their higher risk of poor outcomes with COVID infection, difficulties communicating with masks, social isolation, more significant hearing loss, less awareness, and less likelihood of seeking care (22,23).…”

Incidence of Cochlear Implantation Among Adult Candidates in the United States

“…Importantly, this study presents data through 2019, before the start of the COVID-19 pandemic, which had a significant impact on the rates of CI performed in the US (23). Although CI practices are recovering from the effects of the pandemic, rates of CI may not have recovered to the pre-pandemic numbers described above.…”