French Society of ENT (SFORL) Guidelines. Indications for Cochlear Implantation in Adults
European Annals of Otorhinolaryngology, Head and Neck Diseases
Hermann, R., Lescanne, E., et al. (2019).
European Annals of Otorhinolaryngology, Head and Neck Diseases, 136(3), 193-197.
This guideline from the French Society of ENT, or Société Francaise d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL), provides good practice recommendations on cochlear implantation in adults.
French Society of ENT (SFORL; France)
This document is an official English translation of a guideline written originally in French. The original French guideline contains recommendations for cochlear implantation in both adult and pediatric populations, while the English translation was split into two separate documents: one for adults and one for children. This document addresses the adult population. See the Associated Article section below to find the document for the pediatric population.
For adults considering cochlear implantation, "the patient should be informed of the risk of immediate and long-term postoperative loss of residual hearing after cochlear implantation" (Grade C Recommendation; p. 195).
Adults with single-sided deafness (SSD) considering cochlear implantation (CI) should be informed<ul> <li>that CI on the SSD controls disabling tinnitus in many cases (Grade B Recommendation; p. 195); and </li> <li>that CI "is more effective than air- or bone-conduction CROS (contralateral routing of signal) systems" for speech perception and/or acoustic localization (Grade B Recommendation; p. 195). </li></ul>
For assessing the quality of life (QoL) of adults who receive a cochlear implant, "patients’ quality of life should be assessed before and after cochlear implantation, as a complement to audiometry" (Grade A Recommendation; p. 196). "It is recommended to use several age-adapted versions of a given QoL assessment instrument" (Expert Opinion; p. 196).
After cochlear implantation in adults:<ul> <li>"Rehabilitation should combine acoustic and electrical stimulation when residual low-frequency hearing has been preserved" (Grade B Recommendation; p. 195).</li> <li>"If there is residual hearing in the ear contralateral to the implant, adults should be encouraged to wear a hearing aid"(Grade B Recommendation; p. 195).</li></ul>
When determining general candidacy for cochlear implantation (CI) in adults:<ul> <li>"There is no upper age limit ... if neuropsychological assessment has been made and there is no proven dementia" (Grade A Recommendation; p. 194).</li> <li>"Cognitive disorder is not a contraindication" (Grade B Recommendation; p. 194).</li> <li>The CI candidate "should be totally or partially autonomous or have the requisite help to look after the equipment" (Expert Opinion; p. 194).</li></ul>
For assessing bilateral cochlear implantation candidacy in adults:
<ul>
<li>"At least one of the standardized hearing-in-noise and localization tests should be used to assess binaural hearing" in patients with hearing loss (Expert Opinion; p. 194).</li>
<li>"The benefit provided by a contralateral hearing aid should be assessed on perceptual tests and suitable questionnaires before suggesting implant bilateralization" (Grade C Recommendation; p. 195).</li>
<li>"If a hearing aid contralateral to the implant fails to improve horizontal localization.... or speech perception in noise, implant bilateralization should be proposed, as results are better than with a unilateral cochlear implant" (Grades C Recommendation; p. 194).</li>
<li>"If a hearing aid contralateral to the implant fails to improve quality of life, implant bilateralization should be proposed"(Grades B Recommendation; p. 194).</li>
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