Evaluation of a De-Escalated Post-Operative Cochlear Implant Programming Protocol.

Abstract

Cochlear implantation often requires frequent post-operative programming visits which can disrupt daily life, impose financial burdens, and delay access for new cochlear implant (CI) candidates. This study evaluated the feasibility of a de-escalated schedule of four programming appointments within the first year after surgery. A retrospective review was completed for 236 patients aged 0-100 years who received CI from July 2022 to December 2023. Explants, reimplants and second CI within the study window were excluded. Collected data included demographics, schedule adherence, additional visit reason, and Consonant-Nucleus-Consonant (CNC) word scores for adults. A total of 201 CI recipients (mean age 46.9 years; 72.6% adults) met inclusion criteria. Most were male (53%), White (88%), Non-Hispanic (54.7%), and privately insured (56.2%). Overall, 53% adhered to the 4-visit protocol, 35% required 1-2 additional visits, and 12% required 3-6. Among those requiring additional appointments (n = 95), 28.4% followed the prior protocol of up to 10+ visits. Adherence to the new streamlined protocol improved by 43% over the study period. On multivariate analysis, each additional year of age at surgery reduced the odds of adherence by 3.4% (p < 0.05). No statistical or clinical differences were observed in 12-month CNC scores between patients with ≤ 4 versus > 4 visits. A de-escalated post-CI programming schedule of four visits in the first year is feasible and does not compromise adult speech perception outcomes. Older patients may require closer follow-up. Successful implementation may require time for workflows and provider adoption.