External Validation of Cochlear Implant Screening Tools Demonstrates Modest Generalizability

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Objective To assess the clinical application of five recently published cochlear implant (CI) candidacy evaluation (CICE) referral screening tools through external validation. Study Design Retrospective cohort study. Setting Tertiary otology/neurotology practice. Patients Adults who underwent CICE between December 2020 and September 2021. Intervention(s) CICE referral screening tools versus CI candidacy criteria. Main Outcome Measure(s) CICE screening tool performance, based on the ability to identify patients who met the CI candidacy criteria, was evaluated. CI candidacy criteria were defined as best-aided AzBio sentences at +10 signal-to-noise ratio and either 60% or less accuracy to reflect traditional criteria used in clinical settings or 40% or less accuracy (only patients 65 years or older) to reflect Medicare-eligible criteria. Results Screening criteria of proposed CICE referral tools vary widely across pure-tone average and word recognition scores. When screened by traditional criteria, the sensitivities and specificities of these referral tools varied from 40 to 77% and from 22 to 86%, respectively. When screened by Medicare-eligible criteria, sensitivities and specificities varied from 41 to 81% and from 24 to 91%, respectively. The screening tool proposed by Zwolan et al. (Otol Neurotol 2020;41(7):895-900) demonstrated the best overall performance for traditional (Youden's J, 0.37; sensitivity, 62%; specificity, 75%) and Medicare-eligible patients (Youden's J, 0.44; sensitivity, 66%; specificity, 78%). All screening tools performed worse on the validation cohort compared with their respective development cohorts. Conclusions Current tools for determining CICE referral have diverse screening criteria. These combinations of pure-tone average and word recognition score are modestly successful at identifying CI candidates.

Original languageEnglish
Pages (from-to)E1000-E1007
JournalOtology and Neurotology
Issue number9
StatePublished - Oct 1 2022


  • Cochlear implant candidacy evaluation
  • External validation
  • Screening tool


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