International guidelines on adult cochlear implant candidacy are limited, and country-specific guidelines are varied, leading to disparate levels of access and systemic underutilization across the world. Without standard clinical guidelines, individuals who can benefit from a cochlear implant may not receive one.

In 2020, consensus around cochlear implant candidacy was agreed and the International Consensus Paper created in response. We are delighted to be able to offer you access to the International Consensus Paper here.

Adult Hearing aims to increase awareness via the latest clinical evidence to reach an agreed standard of care for adults with hearing loss.

Watch the video to discover more about Adult Hearing’s aim and purpose.

Please imagine a realistic utopia for those with hearing loss and marshal the best available science to recommend transformational actions to achieve that vision.

Richard Horton, Editor-in-Chief, The Lancet

Listen to an interview with Craig A. Buchman, author of ‘Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements’.


Hearing loss is one of the leading causes of disability worldwide, affecting 466 million people (6% of the total population). It is expected that there will be 630 million people living with disabling hearing loss by the year 2030, with that number rising to over 900 million by 20501, 2 if unaddressed.

Hearing loss has a substantial impact on people’s lives, including, but not limited to:

  • communication difficulties 3
  • social isolation4
  • depression5
  • falls6 and
  • increased healthcare utilisation7

In addition, it is the single largest modifiable risk factor for dementia.8


Presented by Professor Frank Lin from the John Hopkins Bloomberg School of Public Health.


Sensorineural hearing loss (SNHL) is caused by dysfunction of the cochlea, auditory nerve, or central auditory pathways. In many cases, SNHL in adults is attributed to presbycusis, which is a progressive and irreversible bilateral age-related SNHL, whose primary pathology involves the hair cells, stria vascularis and afferent spiral ganglion cells, in addition to the central auditory pathways.9-11


Cochlear implants (CIs) are currently the most successful neuro-prosthesis used across healthcare.16 Although hearing aids are effective for many adults with hearing loss, CIs can provide further benefit to individuals affected by bilateral severe, profound, or moderate sloping to profound SNHL who receive little or no benefit from hearing aids.17

A CI is a surgically implanted device that electrically stimulates the peripheral auditory nerve and associated spiral ganglion cells directly, restoring the individual’s perception of sound.18 A key advantage of a CI over a hearing aid is that, while a hearing aid simply amplifies sound, a CI will directly stimulate the auditory nerve, bypassing injured hair cells of the cochlea and providing salient coded information for better speech perception.19


International guidelines on adult CI candidacy are limited, and country-specific guidelines are varied, leading to disparate levels of access and systemic underutilisation across the world.9,20-22 For example, in the UK, the audiometric criteria for CI candidacy include severe to profound hearing loss at two or more frequencies, with no adequate benefit from conventional hearing aids;9 however, in the USA, the criteria include moderate to profound SNHL, or greater, with little or no benefit from hearing aids.19

Cochlear implantation is still not a routine intervention in adults with significant hearing loss in many regions. Without standard clinical guidelines, individuals who can benefit from a CI may not receive one. Barriers to access include a lack of awareness and understanding of CIs in individuals with SNHL, low awareness and understanding of the candidacy criteria for cochlear implantation among healthcare professionals, and a lack of defined care pathways to provide this important intervention.23,24

A world in which hearing loss is no longer a barrier to human communication and fulfilment.

Angela Merkel


What is a cochlear implant? Love Island contestant Tasha Ghouri’s hearing device explained

Sourced from Metro UK



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the United States. Cochlear implants international. 2013 Mar 1;14(sup1):S12-4.
2. De Raeve L. Cochlear implants in Belgium: Prevalence in paediatric and adult cochlear implantation. European annals of otorhinolaryngology, head and neck diseases. 2016 Jun 1;133:S57-60.h
3. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
4. Jiam NT, Li C, Agrawal Y. Hearing loss and falls: a systematic review and meta-analysis. Laryngoscope. 2016;126(11):2587-2596.
5. Hsu AK, McKee M, Williams S, et al. Associations among hearing loss, hospitalization, readmission and mortality in older adults: A systematic review. Geriatr Nurs. 2019;40(4):367-379.
6. National Institute for Health and Care Excellence. Cochlear implants for children and adults with severe to profound deafness (TA566). 2019. https://www.nice.org.uk/guidance/ta566/resources/cochlear-implants-for-children-and-adults-with-severe-to-profound-deafness-pdf-82607085698245. Accessed June, 2019.
7. Keithley EM. Pathology and mechanisms of cochlear aging [published online May 7, 2019] J Neurosci Res.doi:10.1002/jnr.24439.
8. Roehm CEM, J.; Parnham, K. Presbycusis. Encyclopedia of Otolaryngology, Head and Neck Surgery: Springer, Berlin, Heidelberg; 2013.
9. World Health Organization. WHO global estimates on prevalence of hearing loss. Mortality and burden of diseases and prevention of blindness and deafness. 2012. http://www.who.int/pbd/deafness/WHO_GE_HL.pdf. Accessed November, 2017.
10. Bubbico L, Rosano A, Spagnolo A. Prevalence of prelingual deafness in Italy. Acta Otorhinolaryngol Ital. 2007;27(1):17-21.
11. Rosenhall U, Hederstierna C, Idrizbegovic E. Otological diagnoses and probable age-related auditory neuropathy in “younger” and “older” elderly persons. Int J Audiol. 2011;50(9):578-581.
12. Jung D, Bhattacharyya N. Association of hearing loss with decreased employment and income among adults in the United States. Ann Otol Rhinol Laryngol. 2012;121(12):771-775.
13. Sato M, Baumhoff P, Kral A. Cochlear implant stimulation of a hearing ear generates separate electrophonic and electroneural responses. J Neurosci. 2016;36(1):54-64.
14. Korver AM, Smith RJ, Van Camp G, et al. Congenital hearing loss. Nat Rev Dis Primers. 2017;3:16094.
15. Yawn R, Hunter JB, Sweeney AD, Bennett ML. Cochlear implantation: a biomechanical prosthesis for hearing loss. F1000Prime Rep. 2015;7:45.
16. Raine C, Vickers D. Worldwide picture of candidacy for cochlear implantation. Ent and audiology news 2017; 26 (Sep/Oct).
17. Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Society of Otorhinolaryngology Head and Neck Surgery CMAHaSRCoCAo. [Guideline of cochlear implant (2013)]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014;49(2):89-95.
18. Liang Q, Mason B. Enter the dragon – China’s journey to the hearing world. Cochlear Implants Int. 2013;14 (suppl 1):S26-31.
19. Raine C. Cochlear implants in the United Kingdom: awareness and utilization. Cochlear Implants Int. 2013;14 (suppl 1):S32-37.
20. Sorkin DL. Cochlear implantation in the world’s largest medical device market: utilization and awareness of cochlear implants in the United States. Cochlear Implants Int. 2013;14 (suppl 1):S4-12.
21. Nct. Efficacy and Safety Study of Botulinum Toxin Type A for Moderate to Severe Crow’s Feet Lines. https://clinicaltrialsgov/show/nct01776606. 2013.
22. Eubank BH, Mohtadi NG, Lafave MR, et al. Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology. BMC Med Res Methodol. 2016;16:56.
23. Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am. 2003;85(1):1-3.
24. Appelbaum EN, Yoo SS, Perera RA, Coelho DH. Duration of eligibility prior to cochlear implantation: have we made any progress? Otol Neurotol. 2017;38(9):1273-1277.