Developing a consistent approach to optimising care for hard of hearing adults who may not receive adequate benefit from hearing aids is essential to overcoming the burden affecting 1 in 5 adults globally1.

In many countries, adults do not have their hearing assessed as part of regular health check-ups.

Of those who receive hearing checks and are diagnosed with severe, profound, or moderate sloping to profound (SNHL), few are referred to an appropriately qualified hearing specialist to examine whether an implantable hearing device is indicated as the most beneficial treatment option.3

There is currently no global guidance or set of guidelines that are applicable for Adult Cochlear Implantation (CI).

Building on the publication; Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss (Buchman et al.), this project aims to create living practice guidelines that can be adapted and adopted in country, to optimise the care for adults eligible for CI.

CIICA Conversation: Adults with CI talking about the Living Guidelines Project

Cochlear Implant International Community of Action (CIICA)

Click to hear Meredith Holcomb Au.D. Co-Chair of the Living Guidelines Task Force explain the rationale behind the Living Guidelines.

Click to watch a 3 minute video of Professor Cathy Birman, Task Force member and ENT, Sydney, Australia, presenting on the Living Guidelines Project at APSCI 21.

Click to hear from cochlear implant users and professionals on the importance of addressing the guidelines for adult cochlear implantation. Our thanks to the Pindrop Foundation  for their kind permission in using footage from patients and professionals.

Click to hear from Meredith Holcomb AuD. on the development of Living Guidelines. Recorded November 2022.

International Community of Stakeholders

Stakeholders play a vital role in optimising the care for adults eligible for CI. The Co-development of guidance and guidelines with hearing partners is key to ensuring the process reflects real world settings, as well as the facilitators to overcoming the barriers in the patient journey.

This process will see the inclusive involvement of key stakeholders from subject matter experts to primary care networks across the globe. Conducting efficient and meaningful consultation with key stakeholders will assist to better understand the issues hindering these processes.

The project will have two phases. Phase I will concentrate on refining the guideline scope, target audience and key questions. The second phase of the process will see the guideline framework progress through to guideline creation and communication.

CI users are integral to the process and will be engaged throughout. One key mechanism to do this will be through the Cochlear Implant international Community of Action (CIICA), representing cochlear implant users, other consumer organisations and professional societies to ensure the perspectives of adults with hearing loss are included in the process.

These members will assist and provide input into the development of evidence based and consensus-based recommendations.

Click to view the full PDF

The Task Force will work to translate the evidence into recommendations for the real world. Once the Task Force is aligned and the guidelines and guidance created, there will be a need to inform best evidence patient care to a Broader Stakeholder group and the International Hearing Care Community. This group will consist of those involved in the pathways to care, including primary care specialists, referrers and those linked to the patient pathway. It will also include advocacy organisations. This stage in the process will be crucial to the overall understanding and adoption of the recommendations into clinical practice.

Description of stakeholder groups

Task Force (Scientific Committee): Led by three Co-Chairs, the Task Force will create a global Scientific Committee supporting the effective development and subsequent dissemination of a set of accurate, consistent and usable guidelines.

Meet the Task Force


Meredith Holcomb
United States of America

Director, Hearing Implant Program, University of Miami, Miller School of Medicine, Department of Otolaryngology

Dr Holcomb joined the University of Miami in 2019 as the Director of Cochlear Implants. She received her AuD from the University of North Carolina at Chapel Hill in 2006. She was employed at the Medical University of South Carolina from 2006-2019 where she primarily worked with adult and pediatric cochlear implants. As well, she was the 2016 recipient of the “Outstanding Clinician Award” at MUSC.

Leo De Raeve

Acting Chair of CIICA (Cochlear Implant International Community of Action), Scientific Advisor  of EURO-CIU (European Association of Cochlear Implant Users) and Director of ONICI (Independent Information and Research Center on Cochlear Implantation)

PhD De Raeve has Doctor in Medical Sciences, psychologist and teacher of the deaf. He has more than 35 years of experience in working with deaf children and their families and in deaf education and rehabilitation at KIDS Royal School for the Deaf in Hasselt (Belgium).

Since 2002, he is Director of the Independent Information and Research Center on Cochlear Implants (ONICI).

In 2008 he became Scientific Advisor of the European Users Association of Cochlear Implant Users called “EURO-CIU”, and in 2020 he became Acting Chair of the CIICA steering committee.

Ángel Ramos Macías

Professor, University of Las Palmas. School of Medicine, Department of Otolaryngology – Head and Neck Surgery and Maxillofacial

Prof. Dr. Macías received his Doctor of Medicine and Surgery from the University of Salamanca in 1990 and has over 30 years experience as a Specialist in Otorhinolaryngology. He is currently the Head and Director of the Department of Otolaryngology at the Insular University Hospital of Gran Canaria, as well as a  Professor at the University of Las Palmas.

Prof. Dr. Marcías also holds the positions of Secretary General of the Ibero-American Group of Cochlear Implants and Related Sciences, and the President of the National Otology Comission. Spanish Society of ENT (SEORL).

Meet the Task Force Members

The Co-Chairs are supported by Task Force Members comprised of experts in the field of CI use, including recipients, audiologists and ear, nose and throat specialists from across 20 countries.

Mohamed ElShazly

Darja Pajk

Shakeel Saeed
United Kingdom

Laura Turton
United Kingdom

Timo Stöver

Ulrich Hoppe

Åsa Skagerstrand

Domenico Cuda

Stefano Berrettini

Bernard Fraysse

Michal Luntz

Catherine Birman

Pádraig Kitterick

Tatsuya Yamasoba

Bamini Gopinath

Cath McMahon

Claire Iseli

Mohan Kameswaran

Neelam Vaid

Hao WU

Jenny Loo

Holly Teagle
New Zealand

Seung Ha Oh
South Korea

Katie Neal

Peter Wolnizer

Nina Quinn

Esther Vivas
United States of America

Piotr Henryk Skarżyński

Alejandra Ullauri
United States of America

Paul Mick

Lise Hamlin
United States of America

Sarah Sydlowski
United States of America

Matthew Carlson
United States of America

Erin Miller
United States of America

Regina Presley
United States of America

Alicia Spoor
United States of America

Craig Buchman
United States of America

Oliver Adunka
United States of America

Maura Cosetti
United States of America

Richard Gurgel
United States of America

Natalie Morog

Alejandro Rivas
United States of America

Federico diLella

Ricardo Bento

Task Force Representation

The Task Force brings together subject matter experts from organisations tasked with collaboratively developing living practice guidelines, to optimise the standard of care for adults eligible for cochlear implantation via an evidence based, real time repository under the governance of a coalition of the willing.

Member affiliations will extend to national and international organisations and a wide range of stakeholders including society representatives, speech language therapists, general practitioners (GPs), hearing aid specialists, audiologists, ear, nose and throat (ENT)/ENT GP, payer/policy, non-government organisations (NGOs), governmental agencies, academia, organisations implementing hearing care solutions within the community and most importantly patient representatives who represent the real world experience of those with severe to profound sensorineural hearing loss (SPSNHL).

Broader Stakeholder Consultations: Once the initial phase of guidelines creation is complete, a second phase of communication and implementation will commence. This phase will involve key subject matter experts and may include organisations, speciality bodies or a range of stakeholders defined by the Task Force. The goal for their involvement will be to obtain advice and feedback on recommendations or specific aspects of the Guidelines that require additional expert advice. Inclusion of additional stakeholders will ensure the recommendations are appropriate and increase buy-in and consensus on the final guideline recommendations. Stakeholder mapping will be carried out by the Task Force, to ensure a diverse group of stakeholders are identified from consumers and patient advocacy groups to GPs, hearing aid technicians, audiologists, payers, health economists and peak bodies.

Examples of other living guidelines from other allied health sectors can be found at this link.


For any enquiries on the living guidelines project, kindly contact the coordination team indicated below.

Coordination team:

Irene Deltetto, Director, Healthcare Strategy and Innovation, Health Technology Analysts

Colman Taylor, Chief Vision Officer, Health Technology Analysts


  1. Buchman CA, Gifford RH, Haynes DS, Lenarz T, O’Donoghue G, Adunka O, et al. Unilateral cochlear implants for severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss: A systematic review and consensus statements. JAMA Otolaryngology–Head & Neck Surgery. 2020;146(10):942-53.
  2. Sorkin DL. Access to cochlear implantation. Taylor & Francis; 2013.
  3. ENT Referral Studies, Frost & Sullivan (2010); Cochlear Segmentation Study (2016); PBS ‘Brand Tracker for Professionals’ (CAM) (2017); Better Hearing Institute: MarkeTrak 9 (2015); Cochlear Country Team Intelligence.