Worldwide trends in bilateral cochlear implantation

Abstract

Objectives/Hypothesis: The goal of this study is to ascertain worldwide experience with bilateral cochlear implantation (BCI) with regard to patient demographics, trends in provision of BCI to adult and child patient populations, differences and similarities in BCI candidacy criteria, diagnostic requirements, and treatment approaches among clinicians in high-volume cochlear implant centers. Study Design: Retrospective/prospective. Methods: An electronic survey consisting of 59 mainly multiple-choice questions was developed for online completion. It examined the implant experience and clinical opinion of expert cochlear implant (CI) centers worldwide on the indications, motivations, and contraindications for adult and pediatric, simultaneous and sequential BCI candidacy. Centers were chosen to complete the survey based on their known reputation as a center of excellence. Patient demographics were queried for two time periods to elucidate trends: 2006 and prior, and for the year 2007. Results: Seventy-one percent (25/35) of the CI clinics approached completed the survey. Collectively, these 25 clinics represent experience with approximately 23,200 CI users globally, representing 15% of the total estimated CI population worldwide. The total number of BCI surgeries reflected in their experience (2,880) represents 36% of the estimated number worldwide as of December 2007. Cumulatively to the end of 2007, 70% of all BCI surgeries have occurred in children, with the 3- to 10-year-old age group having the highest representation (33% of all BCIs), followed in order by adults (30%), children under 3 years of age (26%), and children between 11 and 18 years of age (11%). Seventy-two percent of all BCI surgeries were performed sequentially (70% of children, 76% of adults). Children <3 years of age represent the only age group of all patients in which simultaneous surgeries predominate (58% simultaneous). For all other age groups, sequential surgeries far outnumber simultaneous (3-10 years, 84% sequential; 11-18 years, 94% sequential; adults, 76% sequential). Prior to January 2007, 68% of BCIs were performed in children. This increased to 79% for the year 2007 (P <3 years made up only 33%. In 2007 this shifted more toward the younger age group (47% for those <3 years and 40% for 3-10-year-olds; P