Several of the limiting factors will be known before implantation. Longstanding deafness (of several decades) and prelingual hearing loss, in which the patient’s speech quality is unintelligible, are two conditions in which the hearing outcomes are variable. Preimplant counselling is important in these patient groups, with the aims of implantation being awareness of environmental sounds and an aid to lip reading, rather than speech perception. The option of cochlear implant surgery under local anaesthesia is appealing to patients concerned about the potential effects of general anaesthetic agents.
Patient support associations such as Cicada (www.cicada.org.au) play an important role informing patients and families of the range of possible outcomes after cochlear implantation. Information about the assessment process, surgery to place the devices and the rehabilitation process following the switching on of the cochlear implant is conveyed by means of a series of informal social events and information sessions. Future candidates have the opportunity to meet previous cochlear implantation recipients and view their outcomes and experiences from both the patient and the family perspective.
The role of the GP
The GP has an important role in recognising potential candidates for cochlear implantation and facilitating their preliminary investigations – particularly basic audiometry and temporal bone imaging. For instance, difficulty hearing phone conversations with well-adjusted hearing aids is a reasonable trigger for a patient to be assessed for a cochlear implant. Two case studies illustrating the journey to cochlear implantation of adult patients with different causes of hearing loss are presented in Box 1 and Box 2.
The availability of funding streams for adults requiring cochlear implants has improved considerably. Higher levels of private health insurance cover most costs and public funding is available for uninsured patients, although waiting lists in some areas can be lengthy.
Although originally designed for paediatric cohorts, cochlear devices are being increasingly implanted with great success in adult patients who have severe hearing loss. This trend is likely to continue as the longevity in the ageing population increases, funding streams become available and the association between hearing and cognition strengthens. GPs have an important role in identifying patients who are suitable for cochlear implantation and facilitating referral to an appropriate ENT specialist. MT
COMPETING INTERESTS: None.