Further Evidence for the Expansion of Adult Cochlear Implant Candidacy Criteria

Objective: 1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring >= 30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the postoperative performance trajectory for this group of higher performing patients. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: One hundred four (105 ears) postlingually deafened adults who scored >= 30% CNC word recognition in the ear to be implanted preoperatively. Interventions: One hundred four subjects underwent cochlear implantation. Main Outcome Measures: Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI. Results: Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition. Conclusions: CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%.