Cochlear Implant Programming on a Global Scale
As we are each familiar, cochlear implant (CI) programming (i.e., "mapping") is a necessary step in the post-operative aural rehabilitation of the CI patient. However, excellent clinical practice guides appear to be lacking, in general, from a global perspective. The authors distributed a questionnaire to 47 CI centers, following more than 47,000 CI patients and, of note, each questionnaire was returned. View the distributed questionnaire.
Among the findings, in general, CI programming occurs in one session with additional fine tuning sessions over three consecutive monthly follow-up sessions, then three additional visits every three months or so, and then annual follow-up visits. Each visit lasts approximately one hour.
The primary goal of the programming/follow-up sessions is to set the maximum loudness, based on the subjective report of the patient (although pure tine averages and speech audiometry may also play a role). The authors report objective measures may play only a small role in "the global MAP" and other MAP parameters are rarely modified and there exists "huge variation" in the fitting practices related to CIs.
They state that "training in fitting is usually provided primarily by the CI manufacturers, and, although there are guidelines and recommendations, no standardized methodology exists. There are no agreed standards or targets for what should be adjusted or the outcomes expected; as a consequence the MAP a recipient receives could be very different depending on the center visited and the individual heuristics of the audiologist responsible."
The authors conclude that in general, it seems fair to state the current state of the art, as it relates to CI fitting/programming globally consists primarily of setting "maximum current levels and to a lesser extent of minimum current levels, mainly based on subjective feedback from the CI user…."
For More Information, References, and Recommendations
Vaerenberg, Smits, De Ceulaer, Zir, Harman, Jaspers, Tam, Dillon, Wesarg, Martin-Bonniot, Gärtner, Cozma,Kosaner, Prentiss, Sasidharan, Briaire, Bradley, Debruyne, Hollow, Patadia, Mens,Veekmans, Greisiger, Harboun-Cohen, Borel, Tavora-Vieira, Mancini, Cullington, Han-Chi Ng, Walkowiak, Shapiro, Govaerts. (2014) Cochlear Implant Programming A Global Survey on the State of the Art. Scientific World Journal Article ID 50173812.