Hearing aid or cochlear implant? A reasoned approach to deciding when to prescribe a cochlear implant
DOI:
https://doi.org/10.51445/sja.auditio.vol9.2025.120Keywords:
Hearing loss, cochlear implant, hearing aid, indicationsAbstract
Cochlear implants (CIs) were approved as a treatment for profound hearing loss in 1985 in the United States and in 1995 in Spain. Since then, CI indication criteria have evolved in parallel with scientific and technological advances in these devices. Currently, people with severe bilateral hearing loss (≥70 dB HL) are candidates for CIs in most countries. The objective of this study is to investigate whether borderline patients who do not reach severe hearing loss could perform better with CIs than with hearing aids. The scientific evidence analyzed shows that patients with average audiometric thresholds (0.5-2 kHz) of 65 dB HL have an 80% probability of performing better with a CI than with one or two hearing aids. The evidence also shows that monosyllabic word recognition is more sensitive for detecting CI candidates than sentence recognition. Individuals with preoperative word recognition scores below 60% in the best aided condition will perform better with a CI and a contralateral hearing aid than with two hearing aids. Implantation reduces the emotional and social impact of hearing loss and improves the quality of life of these individuals. Our conclusions are consistent with recent studies and international reports suggesting that practitioners should consider referring patients for CI candidacy evaluation when they have audiometric thresholds >60–65 dB HL and word recognition scores <60% in the best aided condition.
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