Effectiveness of Cochlear Implants in Adults with Sensorineural Hearing Loss. Technology Assessment Report

摘要

Sensorineural hearing loss is the third leading cause of disability during the adult years, according to the World Health Organization. This type of hearing loss is usually permanent, most commonly occurs gradually, and becomes worse with increasing age with clinical manifestations typically appearing during the fifth and sixth decades. In recent years, cochlear implants have been used in adults with sensorineural hearing loss. Cochlear implants replace the function of hair cells that are no longer able to generate electrical impulses in response to sound. Therefore, these devices may provide a viable alternative to hearing aids among older adults with sensorineural hearing loss as they bypass damaged hair cells by directly transmitting the electrical impulses to the acoustic nerve. Currently, most patients are fitted unilaterally, with some receiving contralateral assistance with a hearing aid when residual low-frequency hearing exists. In recent years, the number of people implanted bilaterally has continued to increase. Therefore, the Centers for Medicare and Medicaid Services (CMS) is interested in an evaluation of recent published literature on the effectiveness of cochlear implantation. After consultation with the Agency for Healthcare Research and Quality (AHRQ) and CMS, this technology assessment has been commissioned specifically to evaluate the clinical effectiveness of unilateral cochlear implants and bilateral cochlear implants in adult patients (18 years of age) with sensorineural hearing loss. The key questions were formulated in consultation with CMS and AHRQ.