GOOD PRACTICE STATEMENT 2

Additional programming sessions should be scheduled if certain changes in the person’s auditory responsiveness or speech production occur. These changes include, but are not limited to:

• Changes in auditory discrimination

• Increased request for repetition

• Omission of sounds

• Prolongation of vowels

• Change in vocal quality or volume

• Intermittency

• Fluctuation in hearing with device

• Balance issues

• Head trauma

Rationale

• Infection or other medical concerns for the cochlear implant site

• Anxiety

• Depression

• Cognitive impairment

• Non-auditory stimulation

• Sub-optimal hearing levels/progression

• Technology updates

No studies were identified that met the inclusion criteria. Following a review of existing guidelines and in consultation with the CI Task Force, a consensus-based recommendation was developed.

Existing guidelines provided insight to inform the current recommendation. The American Academy of Audiology proposed a specific follow-up schedule of at least six appointments in the first twelve months. The recommendation proposed a prescription of appointments starting with the initial activation appointment taking place one to four weeks post-surgery. Follow-up appointments then took place at one week, one month, three months, six months, and twelve months post-activation.1 Additionally, recent the Delphi consensus guidelines found evidence suggesting frequent programming and fitting assessments within the first six months with an expectation to reduce appointment frequency six months onwards. However, due to inconsistencies in existing guidelines, an individualised approach to programming for cochlear implant users in their first year of device use was recommended taking into account their unique stimulation needs. Person-centred care in cochlear implant programming and rehabilitation has been previously recommended and is considered an important factor in achieving positive hearing health outcomes by the CI Task Force and through consultation with CIICA. 2,3

To optimise speech perception, it is recommended that users should undergo between four to six programming appointments within the first year after their initial activation session. The CI Task Force feedback provided insight on the emphasis that is required to ensure that user preference and variability was represented appropriately. Additionally, this allows the cochlear implant user to become accustomed to the device and ensures that the upper and lower stimulation levels are programmed appropriately. The CI Task Force also expressed a need to highlight circumstances where additional appointments in the first twelve months would be required. As such, a good practice statement addressing scenarios where a cochlear implant user may need additional programming appointments was developed.

Prospero Question

For adult cochlear implant users with severe, profound or moderate sloping to profound sensorineural hearing loss, what are the essential components of an appropriate clinical pathway for rehabilitation after surgery?

Consensus Recommendation 7

Cochlear implant rehabilitation for a user with severe to profound or moderate sloping to profound sensorineural hearing loss should be a multidisciplinary and person-centred approach. The essential members of the multidisciplinary cochlear implant team include:

• Ear, Nose and Throat specialist specialised in cochlear implants

• Audiologist (or equivalent)

• Speech therapist

The multidisciplinary cochlear implant team may involve other specialties including:

• Psychologist, Social worker, Neurologist, Radiologist, Geriatrician, Peer group support

The multidisciplinary cochlear implant team should consider initial rehabilitation (rehabilitation in the first year following cochlear implantation) and lifelong rehabilitation (ongoing rehabilitation after the first year of cochlear implantation).

The person, their family and/or friends should collaboratively plan their cochlear implant rehabilitation with their multidisciplinary team.