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Original Investigation
August 27, 2020

Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition: A Multicenter Nonrandomized Clinical Trial

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, Ann Arbor
  • 2Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 3Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery
JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.2286
Key Points

Question  Are current cochlear implant systems effective when provided to newly implanted Centers for Medicare & Medicaid Services beneficiaries who demonstrate a preoperative sentence recognition score of 41% to 60% in their best-aided condition?

Findings  In this multicenter nonrandomized trial of 31 participants 65 years or older with moderate to profound hearing loss who received cochlear implants, significant improvement in sentence recognition was observed both in the implant ear alone and in the best-aided condition when preoperative and postoperative sentence recognition scores were compared. In addition, significant improvements were noted for some scores on questionnaires dealing with device benefit and health utility.

Meaning  Current cochlear implant systems are appropriate for Centers for Medicare & Medicaid Services beneficiaries who demonstrate preoperative best-aided sentence scores that fall between 41% and 60%.


Importance  Current indications for Medicare beneficiaries to receive a cochlear implant are outdated. Multichannel cochlear implant systems may be effective when provided to Medicare beneficiaries using expanded indications.

Objective  To examine the effectiveness of cochlear implants, as measured by improvement on the AzBio Sentence Test, for newly implanted Medicare beneficiaries who meet the expanded indications of an AzBio Sentence Test score of 41% to 60% in their best-aided condition.

Design, Setting, and Participants  A multicenter nonrandomized trial examined preoperative and postoperative speech recognition, telephone communication, hearing device benefit, health utility, and quality of life for 34 participants enrolled at 8 different centers who received a cochlear implant between September 17, 2014, and July 10, 2018. All participants were 65 years or older, had bilateral moderate to profound hearing loss, and had a best-aided preoperative AzBio Sentence Test score in quiet of 41% to 60%. Analysis was performed on an intention-to-treat basis. Statistical analysis of final results took place from July 29 to October 1, 2019.

Intervention  Multichannel cochlear implants.

Main Outcomes and Measures  The study examined the a priori hypothesis that the cochlear implant would improve the AzBio Sentence Test score in the best-aided condition by 25% or more and in the implanted ear–alone condition by 30% or more. The study additionally examined word and telephone recognition and examined device benefit, health utility, and quality of life.

Results  A total of 34 participants received a cochlear implant; 31 (23 men [74%]; median age, 73.6 years [range, 65.7-85.1 years]) completed testing through the 6-month evaluation, and 29 completed testing through the 12-month evaluation. Median preoperative AzBio Sentence Test scores were 53% (range, 26%-60%) for the best-aided condition and 24% (range, 0%-53%) for the cochlear implant–alone condition; median scores 12 months after implantation improved to 89% (range, 36%-100%) for the best-aided condition and 77% (range, 13%-100%) for the cochlear implant–alone condition. This outcome represents a median change of 36% (range, –22% to 75%) for the best-aided condition (lower bound of 1-sided 95% CI, 31%) and a median change of 53% (range, –15% to 93%) for the cochlear implant–alone condition (lower bound of 1-sided 95% CI, 45%).

Conclusions and Relevance  Intervention with a cochlear implant was associated with improved sentence, word, and telephone recognition in adult Medicare beneficiaries whose preoperative AzBio Sentence Test scores were between 41% and 60%. These findings support expansion of the Center for Medicare & Medicaid current indications for cochlear implants.

Trial Registration  ClinicalTrials.gov Identifier: NCT02075229

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