Qualifying Cochlear Implant Candidates—Does it Matter How Patients Are Qualified?

Objective: Evaluate variable qualification criteria for cochlear implant (CI) recipients and 12-month speech perception outcomes. Study Design: Retrospective cohort study. Setting: HERMES national database and nonoverlapping single-institution CI database. Patients: A total of 2,124 adult unilateral CI recipients categorized by qualifying status: AzBio in quiet (n = 1,239), +10 dB SNR (but not in quiet; n = 519), +5 dB SNR (but not in quiet or +10 dB SNR; n = 366); CNC ≤40% (n = 1,037), CNC 41% to 50% (n = 31), and CNC 51% to 60% (n = 20). Interventions: CI. Main Outcome Measures: Pre- and 12-month postoperative speech perception performance. Clinically significant improvement was defined as ≥15% gain. Results: Quiet qualifiers experienced improvement in all listening conditions, whereas +10 dB SNR and +5 dB SNR qualifiers only improved in their qualifying condition and implanted ear CNC. When stratified by expanded Medicare criteria (binaural AzBio ≤60% correct), patients that qualified in quiet experienced improvements regardless of qualifying threshold or background noise. However, those that qualified in noise and AzBio ≤60% experienced mixed results in quiet and limited gain in background noise. When ≤60% criteria was applied to CNC of the worse ear, ≤40% qualifiers experienced large improvements in all tested conditions, but those who qualified by 41% to 50% or 51% to 60% only demonstrated modest improvements in AzBio sentence testing. Conclusions: Quiet qualifiers improved in all testing conditions, while those qualifying in noise improved in their qualifying condition. Patients who qualified by expanded Medicare criteria (≤60%) showed improvement when qualifying with AzBio in quiet, but should be used with caution when qualifying patients in background noise or CNC due to more limited gains in performance.