Connecting people with hearing care
Clinicians strive to provide high quality, patient-centered care to their implant patients. Cochlear is proud to support their efforts with technologies and services that transform how people connect with care across different settings and allow clinicians to optimize outcomes. Our goal is to provide comprehensive tools and support for maximum flexibility in any care setting.
Cochlear’s Adult Cochlear Implant (CI) Care Model is a comprehensive protocol, supporting patients and clinicians at every stage of the journey. Based on evidence and consensus from industry leaders, the Adult CI Care Model modernizes care and maximizes outcomes for every patient. Telehealth and telemedicine are becoming important tools in healthcare and Cochlear is proud to offer Connected Care technologies and services that fully support the care model. Details about our support services are below.
Download the Cochlear™ Nucleus® adult cochlear implant protocol
Adult Cochlear Implant (CI) Clinical Protocol
Candidacy evaluation
The goals of a candidacy evaluation are to evaluate a patient’s current hearing status and determine if they would be better served with a cochlear implant than with their current technology. The Minimum Speech Test Battery (MSTB) should be used for candidacy testing.
The minimum tasks to complete in a candidacy evaluation include:
- Complete audiometric testing
- Verify hearing aid fitting and satisfaction
- Evaluate aided speech recognition to determine cochlear implant candidacy
- Determine treatment recommendations
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Pre-surgical consultation
The goal of a pre-surgical consultation is to prepare the patient for their hearing journey and establish expectations. A pre-surgical visit can be accomplished in many ways. Clinics can consider using telehealth or digital health, a Cochlear Engagement Manager, or Audiology Tech to support this interaction. The pre-surgical consultation may also be part of the Candidacy Evaluation.
The minimum tasks to complete in a pre-surgical consultation include:
- Establish expectations
- Complete order form(s)
- Establish any baseline outcome measures not completed during the candidacy testing
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Activation
Initial activation usually occurs within two weeks from the time of surgery. The goal of activation is to provide audibility of soft sounds to the patient as well as a sufficient dynamic range to allow them to begin to acclimate to sound. For many patients, the acclimatization period will be several weeks, so the goal at activation should be an acceptably loud and audible MAP (not necessarily an optimized MAP).
The minimum tasks to complete in an initial activation include:
- Confirm status of the implanted ear
- Ensure a minimum dynamic range of 40 CL
- Ensure C levels are set to "loud"
- Ensure audibility of soft sounds
- Set expectations of wear time of 10+ hours per day
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Optimization
In the optimization phase, patients will return to the clinic or be seen using Remote Care or telehealth in order to optimize their MAP and processor settings. Patients should be encouraged to wear their device 10+ hours per day in order to acclimate and fully optimize their hearing during this period (and beyond).
The minimum tasks to complete during the optimization phase include:
- Confirm audibility and appropriate loudness
- Inspect implant site and equipment
- Confirm consistent wear time (minimum 10 hours per day)
- Evaluate progress informally or formally
- Optimize the MAP as indicated
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Maintenance
Patients enter the Maintenance phase once they have reached average performance milestones. This typically occurs 90+ days from activation. Patients may be monitored in the clinic or take advantage of remote patient monitoring with Cochlear Remote Care. Patients should enter the maintenance phase when1:
- Post-operative CNC word scores in the implanted ear is 56% or better
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- The patient’s scores in the implanted ear have improved by at least 20% from pre-operative testing
If the patient has not met these milestones, or if other concerns exist, they can remain in the optimization phase for further support.
The minimum tasks to complete during the maintenance phase include:
- Monitor and review hearing goals using patient satisfaction outcomes
- Evaluate changes in hearing and/or lifestyle. Determine the need for further support, including rehabilitation, bilateral CI, sound processor upgrade eligibility, etc.
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More details are available in the full version of the Cochlear Nucleus Adult CI Protocol - please download the document here.
More information
Disclaimer
This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.
For a full list of Cochlear’s trademarks, please visit our Terms of Use page.
References
- Buchman, et al (2020) Assessment of speech understanding after Cochlear Implantation in adult hearing aid users. JAMA Otol Head & Neck Surg, doi:10.1001/jamaoto.2020.1584