BACKGROUND Cochlear implantation (CI) is a highly effective intervention for severe-to-profound hearing loss; however, the COVID-19 pandemic disrupted established CI service delivery worldwide. Maintaining access to this resource-intensive procedure during public health emergencies is critical, particularly for pediatric patients in whom delays may compromise auditory and language development. METHODS This multicenter retrospective comparative study analyzed CI service delivery across seven centers in Bahrain and Saudi Arabia, comparing pre-pandemic and pandemic periods over six months. Data included procedural volumes, waiting lists, committee activity, surgical workflows, intraoperative testing, and adoption of telehealth for fitting and rehabilitation.Generalized estimating equations were used to account for center-level clustering. RESULTS A total of 984 CI procedures were analyzed. Overall implant volume was preserved during the pandemic, while waiting lists increased by 31%. Telehealth adoption expanded markedly, with all remote fitting sessions and nearly all remote rehabilitation sessions occurring during the COVID-19 pandemic. Unilateral operating time decreased significantly, reflecting streamlined surgical workflows. Committee activity and intraoperative testing practices demonstrated center-specific adaptations. CONCLUSION CI services demonstrated resilience during the COVID-19 pandemic through rapid telehealth integration and surgical workflow optimization. However, increased waiting lists highlight critical vulnerability, particularly for pediatric candidates. Hybrid care models and contingency planning should be formally integrated into future CI service frameworks.
OBJECTIVES:This quality improvement (QI) case study conducted at a large adult CI centre aimed to improve access to cochlear implant (CI) care for northern communities. By adapting existing infrastructure using tele-audiology in novel ways, we were able to complete CI candidacy assessments, CI activations and CI speech perception testing remotely. METHOD:Two remote sites were trained and equipped to facilitate remote sessions for expanded CI care services. These collaborating sites were outfitted with CI software, adaptors, and standardized speech testing WAV sound files. CI audiologists from the implant centre, with the support of the local Facilitator, used remote desktop control to complete CI activations, plus streaming technology to evaluate aided speech perception for CI candidacy assessments and CI outcomes. RESULTS:Five remote CI candidacy evaluations and activations were successfully completed, along with three cases of follow-up remote CI speech perception testing without any adverse events. Post-activation surveys indicated a high level of satisfaction among participants. Case studies demonstrated evidence of a high level of agreement as well as a case of high variability between remotely assessed speech recognition scores and those obtained in-person. CONCLUSION:These case reports highlight tele-audiology's potential to enhance access to CI care for underserved regions. Future expansion to include additional CI models and adaptations to other applications such as bone conduction aids is anticipated.
PURPOSE:To answer the following question: what are the expectations of families of children and adolescents regarding the benefits of cochlear implant (CI) use? METHOD:This systematic review included studies assessing family expectations regarding the benefits of CI use in children and adolescents. Searches were performed across Embase, LILACS, PubMed, Scopus, Web of Science, Google Scholar, and ProQuest, without language or year restrictions. A meta-analysis of proportions with a random-effects model (DerSimonian-Laird) was performed, considering only 'strongly agree' responses as high expectations. An odds ratio meta-analysis was also conducted to compare expectations before and after CI activation. RESULTS:Thirty-four studies were included, most presenting a high risk of bias. Approximately 55% of family members reported high expectations for exclusive oral communication, and 39% believed their child would understand speech without lip reading. Around 38% expected enrollment in mainstream schools, although only 14% strongly agreed that their child would keep up with hearing peers. Between 48% and 54% expressed high expectations regarding socialization in different contexts, and about 45% expected satisfactory CI functioning. The meta-analysis suggested a significant increase in expectations after CI activation, particularly for auditory and spoken language development. CONCLUSION:Family expectations regarding the benefits of CI are generally high but vary across domains. Although the meta-analysis suggested an increase in expectations after device activation, the overall certainty of the evidence was low to very low, warranting cautious interpretation.
