Selection Criteria for Cochlear Implantation in the United Kingdom and Flanders: Toward a Less Restrictive Standard.
Tirza F K van der Straaten, Jeroen J Briaire, Deborah Vickers and 2 others
PMID 32590629WHAT IT FOUND
Relaxing UK and Flanders cochlear implant criteria to include patients with better residual hearing increased the number of candidates by 30%.
These newly accepted patients still showed significant speech improvement, though less than those with more severe loss. Only 0.2% of this new group failed to improve.
Key findings
01The new UK and Flanders selection criteria led to the inclusion of approximately 30% more patients, of whom 0.2% did not exhibit postoperative improvement of speech understanding.
02Newly included patients exhibited an average improvement in speech understanding of 41% (UK) and 40% (Flanders), compared to 59% and 60% respectively for those who would have been included under the old, more conservative criteria.
03Preoperative best-aided speech perception tests had the highest diagnostic ability for predicting postoperative improvement, outperforming pure-tone audiometry criteria.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used a Dutch dataset where patients were implanted under lenient criteria, which may not perfectly reflect the outcomes if the stricter UK or Flemish criteria had been applied prospectively. Missing data occurred for 136 patients in quiet settings and 221 in noise settings; while imputation was used, this introduces uncertainty. The analysis focused on speech understanding scores, which do not fully capture subjective benefit in daily life. The study did not include children, so findings do not apply to pediatric candidacy criteria.
Declared interests
The work was supported by Stichting het Heinsius-Houbolt Fonds. Two authors received nonrestrictive research grants from MedEl and Advanced Bionics for other projects. The authors declared no conflicts of interest for this specific study.
The easy way to misread this
Do not assume that newly eligible patients with residual hearing will achieve the same magnitude of speech understanding improvement as those with more severe hearing loss. The data shows they improve, but by a smaller margin (approx. 40-41% vs 59-60%). Expectations should be calibrated accordingly.