The basic technology and methodology of the implant has remained essentially unchanged throughout the past 30 years. Technological improvements have been seen with the size of the devices becoming much smaller and the surgery becoming less traumatic. Sound processing strategies have become more complex in order to block out background noise and wind.
In the regulatory world, the implant has had many successes in the past 30 years. The implant was first approved by the FDA for use in profoundly deaf adults in 1985 and for use in children two years or older in 1990. In 1998 candidacy was expanded to include severely deaf children/adults as well as the profoundly deaf. The age requirement dropped from 2 years to 18 months as well. In 2000 and 2014, further expansions of FDA-approved candidacy took place.One way to gauge whether a patient is a candidate or not is to test word and sentence scores.
From 1998, 2000, and 2014, sentence scores went from 40% to 50% to 60%, respectively. This represents a 50% increase in the amount of hearing an individual has to have before they are considered to have “too much” hearing to be a candidate. Testing previously only used sentence scores; now increasingly using single word test scores and hearing in noise.
FDA changes in guidelines are tied to changes in outcomes; greater numbers of younger children who receive implants are using Oral communication without sign language. Adults and children with severe/profound hearing loss have better outcomes with CIs than with hearing aids.
Even with the technological improvements and expanded candidacy, cochlear implants still have a lot of ground to cover. Cochlear implants are still under-utilized in the adult population and even more so in aging adults. Studies are underway to expand criteria, improve devices, and increase awareness of this life changing technology.