Standards of Care

The 2023 Standards of Care for hearing health includes all of the current clinical practice recommendations and is intended to provide clinicians, patients, researchers, payers, and others with the components of hearing care, general treatment goals, and tools to evaluate the quality of care. The recommendations are based on an extensive review of the clinical hearing literature, supplemented with input from the CI Task Force and Hearing Health Collaborative members and the medical community at large.

The Standards of Care for hearing health are updated annually, or more frequently online if new evidence changes merit immediate incorporation.

Living Guidelines


Developing a consistent approach to optimising care for adults experiencing hearing loss 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 Sensorineural Hearing Loss (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).

The living guidelines for adult cochlear implantation

The Cochlear Implant International Community of Action (CIICA) have published a summary of guideline recommendations. Click here to download the PDF.

Regional guidelines & resources

Select a location below to view region-specific guidelines and resources.

CI Task Force

Meet the Co-chairs

Camille Dunn

Camille C Dunn
United States of America

Associate Professor, University of Iowa, Director, Iowa Cochlear Implant Clinical Research Center Department of Otolaryngology – Head and Neck Surgery.


Camille C Dunn, PhD, joined the Department of Otolaryngology – Head and Neck Surgery at the University of Iowa in 2003 where she is an Associate Professor and the Director of the Cochlear Implant Program. She received her Master of Science degree in 1998 and Doctor of Philosophy Degree in 2003 both from the University of Nebraska-Lincoln.

Dr. Dunn holds her Audiology license from the State of Iowa. She maintains her Certificate of Clinical Competence in Audiology (CCC-A) and is a member of the American Speech-Language-Hearing Association (ASHA) and a Board member on the American Cochlear Implant Alliance (ACIA).

She is a Principal Investigator on a NIH-funded grant to determine the impact of intervention on user’s hearing-related functions and disability in their natural environments.

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).

Meredith Holcomb
United States of America

Co-Chair 2021-23, 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.

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

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.