Cochlear implants are auditory sensory devices designed to provide auditory perception for individuals with significant hearing loss. A majority of individuals who use a cochlear implant have the ability to understand speech in quiet and complex listening environments, and children who were born with hearing loss are now able to develop excellent auditory and spoken language skills with the device. 

Much of a cochlear implant user’s success is dependent on the appropriate selection of a recipient, optimized programming, auditory therapy, and routine follow-up care. Since receiving Food and Drug Administration (FDA) approval in 1984, audiologists have played a critical role in the clinical management of both pediatric and adult cochlear implant recipients. The audiologists’ responsibilities include a range of services, beginning with pre-implant candidacy assessment and extending to long-term post-implantation care. While clinical management is a known primary factor that contributes to success with cochlear implants, there have been no published guidelines to standardize cochlear implant care in their 35 years of clinical practice.  

Due to this critical need for evidence-based standardized cochlear implant care, the Academy Task Force on Guidelines for Cochlear Implants was established in 2015, with the goal of developing a document of guidelines for cochlear implant clinical practice. Statements and recommendations were evidence-based when possible, developed by a review of existing scientific evidence published in both peer-reviewed and non-peer-reviewed journals. When direct evidence was not available, both indirect evidence and consensus practice were considered.

The guideline addresses cochlear implant signal processing, candidacy, surgical considerations, device programming, outcomes assessment and validation, follow-up management, and care beyond programming. This document is designed to serve as a guide in clinical decision-making regarding pre- and post-operative audiological management of cochlear implant recipients. 

Among the greatest challenges in developing these guidelines, as is the case with cochlear implant research, were the limitations in generalizing the recommendations needed for individuals who receive cochlear implants. Cochlear implant outcomes are characterized by wide variabilities that are attributed to many factors outside of clinical control. Therefore, the authors acknowledge the inherent limitations of these guidelines and encourage those who use them to incorporate best clinical knowledge and interpretation of evidence-based practice when working with individual patients. 

Additionally, while the authors acknowledge the importance of emerging research in progressing the field and clinical adoption of new evidence-based approaches to care, it is not within the scope of this document to explore experimental clinical practices related to future directions in cochlear implants

Access the new guideline here.


Acknowledgment

The guidelines document originated as an extensive review of literature prepared by the American Academy of Audiology Task Force on Guidelines for Cochlear Implants. Multiple individuals contributed to the creation of this document. The original task force initiated work on the document in 2015. The members of the 2015 Task Force included Holly Teagle, AuD (Co-Chair); William Shapiro, AuD (Co-Chair); Anne Beiter, MS; Laurie Eisenberg, PhD; Jill Firszt, PhD; Michelle Hughes, PhD; Geoff Plant; Amy Robbins; Tom Walsh; and Terry Zwolan, PhD. 

In 2017, the composition of the task force changed. The members of the 2018 Task Force included Jessica Messersmith, PhD (Chair); Lavin Entwisle, AuD; Sarah Warren, AuD, PhD, and Michael Scott, AuD. The final document, while informed by the document created by the 2015 task force, represents an updated review of the evidence, which allowed for a comprehensive compilation of current knowledge in a format consistent with other Academy guidelines documents.

The task force gratefully acknowledges the contributions of all members.

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