Streamlining The Cochlear Implant Evaluation: Utility Of Community Audiometry In Cochlear Implant Candidacy Assessment

Objective: To identify redundancy in the cochlear implant candidacy evaluation and assess its financial impact. Study design: Retrospective chart review. Setting: Tertiary care academic cochlear implant center. Patients: One hundred thirty-five patients referred for cochlear implant candidacy evaluation from 2004 through 2019. Intervention: Community and academic audiometry were compared in a matched-pair analysis. Main outcome measures: Pure-tone audiometry and word recognition scores (WRS) were compared using the Wilcoxon signed-rank test. Cost of repeated audiometry was estimated using the Medicare Provider Utilization and Payment data. Results: The majority of pure-tone thresholds (PTT) and pure-tone averages (PTA) had no statistically significant differences between community and academic centers. Only air PTT at 2000 Hz on the right and air PTA on the right demonstrated differences with alpha = 0.05 after Bonferroni correction. Despite statistical differences, mean differences in PTT and PTA were all under 3.5 dB. WRS were on average lower at the academic center, by 14.7% on the right (p < 0.001) and 10.6% on the left (p = 0.003). Repeating initial audiometry costs patients up to $60.58 and costs the healthcare system up to $42.94 per patient. Conclusions: Pure-tone audiometry between community and academic centers did not demonstrate clinically significant differences. Lower academic WRS implies that patients identified as potential cochlear implant candidates based on community WRS are likely suitable to proceed to sentence testing without repeating audiometry, saving patients and the healthcare system time and resources.