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Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 5363

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Dr. Meredith Holcomb

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Guest Editor

Department of Otolaryngology, University of Miami, Miami, FL 33136, USA
Interests: cochlear implant outcomes; clinical efficiency; cochlear implant programming

Special Issue Information

Dear Colleagues,

This Special Issue, “Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation”, seeks to address the persistent barriers that continue to limit the full potential of cochlear implant care despite remarkable advances in surgical techniques, device technology, and rehabilitation strategies. Challenges such as delayed referral to implant centers, variability in patient outcomes, disparities in access to care, and the need to optimize long-term auditory and language development remain central obstacles. The scope of this Special Issue spans surgical innovation, candidacy evaluation, patient counseling, clinical efficiency, and multidisciplinary rehabilitation approaches across the lifespan. By bringing together leading voices in otology, audiology, and allied fields, we aim to highlight innovative solutions, strengthen the evidence base, and inspire new models of care that prioritize patient-centered outcomes. Ultimately, this issue seeks to accelerate progress toward more equitable, effective, and personalized approaches to cochlear implantation and hearing rehabilitation, fostering sustained improvements in outcomes and quality of life for individuals with hearing loss worldwide.

Dr. Meredith Holcomb
Guest Editor

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Keywords

cochlear implant outcomes
clinical efficiency
barriers to care
cochlear implant surgery
cochlear implant referral
cochlear implant evaluation
cochlear implant candidacy
rehabilitation
rehabilitation strategies
quality of life

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Published Papers (7 papers)

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17 pages, 3244 KB

Open AccessArticle

Determinants of Cochlear Implant Evaluation Completion and Uptake in Children

by Lisa R. Park, Shannon R. Culbertson, Dahvae Turner, Margaret E. Richter, Caitlin Sapp, Jennifer S. Woodard and Margaret T. Dillon

J. Clin. Med. 2026, 15(7), 2731; https://doi.org/10.3390/jcm15072731 - 4 Apr 2026

Viewed by 597

Abstract

Background/Objectives: Approximately half of US children who meet traditional cochlear implant (CI) candidacy criteria receive an implant. As candidacy expands to include a broader range of hearing configurations, identifying factors that influence referral completion and CI uptake is increasingly important. This study examined the predictors of CI evaluation completion and surgery among children referred for CI assessment, including both traditional and non-traditional candidates. Methods: The medical records of pediatric patients referred for an initial CI evaluation from 2018 through 2024 were reviewed. Referral outcomes were categorized as evaluation not completed, candidate who declined surgery, or candidate who proceeded with surgery. Two binomial logistic regression models assessed the demographic, audiologic, and contextual predictors of CI evaluation completion and CI uptake, including age at referral, candidate type, insurance, referral year, communication mode, race/ethnicity, unaided thresholds, rurality, and county-level social health determinants. Results: The completion of the CI evaluation was significantly influenced by race/ethnicity, candidate type, referral year, and age. Mixed-race children demonstrated higher completion rates than White children. Completion was lower among children with single-sided deafness (SSD), children referred in 2022, and older children. Among children determined to be candidates, 69% proceeded with surgery. CI uptake showed similar patterns, with lower rates among Hispanic children, children with residual hearing or SSD, children referred in 2022, and older children. Conclusions: CI uptake at this center exceeded national averages but was associated with race/ethnicity, candidate type, age, and year of referral. Targeted counseling and outreach may improve timely referral and informed decision-making. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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11 pages, 696 KB

Open AccessArticle

Association of Age-Related Hearing Loss with Domain-Specific Cognitive Performance in Older Adults

by Tatiana Marques, João Castelhano, Isabel Catarina Duarte, Carla Pinto-Moura, Miguel Castelo-Branco and António Miguéis

J. Clin. Med. 2026, 15(6), 2322; https://doi.org/10.3390/jcm15062322 - 18 Mar 2026

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Abstract

Background/Objectives: Age-related hearing loss (ARHL) is highly prevalent among older adults and has been linked to cognitive decline. However, the specific cognitive domains most vulnerable to ARHL and whether these associations exhibit lateralized effects remain unclear, which is critical for understanding and mitigating its broader impact on neurocognitive function. This study aimed to characterize the clinical profile of ARHL and examine associations between hearing thresholds and cognitive performance across domains, including the influence of educational attainment as a proxy for cognitive reserve. Methods: Audiometric assessments and cognitive screening using the Mini-Mental State Examination were conducted in older adults, including normal-hearing listeners (NHL, n = 31, mean age 71.4) and those with hearing loss (HL, n = 46, mean age 73.1). Associations between pure-tone averages, clinical complaints, and cognitive domains were analyzed while considering educational attainment. Results: HL participants exhibited a higher prevalence of tinnitus (NHL: 33.3% vs. HL: 65.2%) and slightly more frequent dizziness compared to their normal-hearing peers. Cognitive assessment revealed that decreased cognitive performance was strongly associated with hearing loss (p < 0.05), and this association was influenced by low educational level. Orientation was the most affected domain (p < 0.01), while recall and language were also significantly associated with low- and high-frequency pure-tone averages, respectively. Conclusions: These findings reinforce the relationship between ARHL and cognitive decline, suggesting an attentional basis whereby higher listening effort to decode the degraded auditory input may affect cognitive performance. The results also highlight the influence of educational attainment as a moderating factor. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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19 pages, 721 KB

Open AccessArticle

Communication Experiences and Challenges in Adult Cochlear Implant Users: Associations with Age and Occupation

by Jack Y. Lin, Hugh M. Birky, Aaron C. Moberly and Terrin N. Tamati

J. Clin. Med. 2026, 15(4), 1450; https://doi.org/10.3390/jcm15041450 - 12 Feb 2026

Viewed by 554

Abstract

Background/Objectives: Over one million individuals have received cochlear implants (CIs) worldwide—a monumental milestone in improving speech perception for those otherwise unable to hear. Although implantation is now routine, communication outcomes vary widely. This study investigated the effects of age and occupational status on the communication challenges of postlingually deafened adult CI users. Methods: Sixty-nine experienced (>6 months of use) CI users between the ages of 18 and 83 years completed a lab-developed survey. Self-reported communication challenges were compared between younger (<65 years) and older (≥65 years) CI users, and between working and retired individuals. Results: Younger CI users placed greater importance on communicating with colleagues than older CI users (p = 0.001), a pattern also observed among those working compared with retired individuals (p < 0.001). Compared with older CI users, younger participants reported fewer difficulties understanding fast (p = 0.012) and unclear speech (p = 0.016), but greater difficulties with soft (p = 0.044) and foreign-accented speech (p = 0.047). Similarly, working CI users reported fewer difficulties with fast (p = 0.028) and unclear speech (p < 0.001). Regardless of age or occupational status, most participants reported persistent listening fatigue and the tendency to avoid difficult conversations. Conclusions: Together, these findings demonstrate that while adult CI users report common struggles like fatigue, specific communication challenges differ across age and occupational status. Recognizing these factors may inform more personalized counseling and rehabilitation strategies to enhance everyday communication outcomes for CI users. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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19 pages, 979 KB

Open AccessEditor’s ChoiceArticle

Long-Term Auditory, Tinnitus, and Psychological Outcomes After Cochlear Implantation in Single-Sided Deafness: A Two-Year Prospective Study

by Jasper Karl Friedrich Schrader, Moritz Gröschel, Agnieszka J. Szczepek and Heidi Olze

J. Clin. Med. 2026, 15(2), 644; https://doi.org/10.3390/jcm15020644 - 13 Jan 2026

Cited by 1 | Viewed by 940

Abstract

Background/Objectives: Single-sided deafness (SSD) impairs speech perception, reduces spatial hearing, decreases quality of life, and is frequently accompanied by tinnitus. Cochlear implantation (CI) has become an established treatment option, but long-term prospective evidence across multiple functional and psychological domains remains limited. This study investigated auditory performance, subjective hearing outcomes, tinnitus burden, and psychological well-being over a two-year follow-up in a large SSD cohort. Methods: Seventy adults with SSD underwent unilateral CI. Assessments were conducted preoperatively and at 6 months, 1 year, and 2 years postoperatively. Outcome measures included the Freiburg Monosyllable Test (FS), Oldenburg Inventory (OI), Nijmegen Cochlear Implant Questionnaire (NCIQ), Tinnitus Questionnaire (TQ), Perceived Stress Questionnaire (PSQ), Generalized Anxiety Disorder scale (GAD-7), and General Depression Scale (ADS-L). Longitudinal changes were analyzed using Wilcoxon signed-rank tests with effect sizes; Holm-adjusted p-values were applied for baseline-to-follow-up comparisons. Results: Speech perception improved markedly within the first 6 months and remained stable through 2 years, with large effect sizes. All OI subdomains demonstrated early and sustained improvements in subjective hearing ability. Several hearing-related quality-of-life domains assessed by the NCIQ, particularly social interaction, self-esteem, and activity participation, showed medium-to-large long-term improvements. Tinnitus severity decreased substantially, with marked reductions observed by 6 months and maintained thereafter; the proportion of tinnitus-free patients increased at follow-up, although tinnitus symptoms persisted in a substantial subset of participants. Perceived stress was reduced initially at the early follow-up and remained below baseline thereafter. Anxiety and depressive symptoms mostly stayed within nonclinical ranges, showing no lasting changes after adjusting for multiple comparisons. Conclusions: In this prospective cohort, cochlear implantation was associated with durable improvements in auditory outcomes, tinnitus burden, and selected patient-reported quality-of-life domains over two years. Although significant functional and patient-centered improvements were noted, persistent tinnitus and diverse psychosocial outcomes underscore the need for personalized counseling and comprehensive follow-up that incorporate patient-reported outcomes and psychological assessments. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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14 pages, 2574 KB

Open AccessArticle

The Role of Patient Motivation in Single-Sided Deafness: Patterns in Treatment Selection and Cochlear Implant Outcomes

by Leena Asfour, Allison Oliva, Erin Williams and Meredith A. Holcomb

J. Clin. Med. 2025, 14(24), 8944; https://doi.org/10.3390/jcm14248944 - 18 Dec 2025

Viewed by 866

Abstract

Background/Objectives: Single-sided deafness (SSD) treatment options include Contralateral Routing of Signal (CROS) or Bilateral Routing of Signal (BiCROS) systems, bone conduction devices, cochlear implants (CIs) and no intervention. Aligning treatment recommendations with patient motivations is fundamental for satisfaction and successful outcomes. At our institution, a structured telehealth consultation precedes formal testing and includes treatment motivation exploration and comprehensive review of all interventions. This study examined SSD treatment motivations and their association with pursuing cochlear implantation. Methods: Adults who completed a pre-treatment SSD telehealth consultation over a four-year period were identified. Charts were retrospectively reviewed for demographics, SSD characteristics, treatment motivations, treatment choice, and CI outcomes. Results: A total of 122 adults were evaluated. Mean age was 56.3 (±13.0) years, and 59.8% were male. Mean SSD duration was 10.8 (±15.8) years. The most common etiology was sudden sensorineural hearing loss. The top primary motivations were improving overall hearing (23.0%), restoring hearing to the deaf ear (22.1%), and improving hearing in noise (21.3%). Most patients (45.1%) opted for a hearing aid, CROS or BiCROS system; 38.5% chose CI; and 14.8% declined treatment. Only 57.4% of those who selected CI had the implant, primarily due to surgery avoidance (31.5%) and insurance limitations (10.5%). Motivation did not predict treatment choice or CI receipt. Among CI recipients (n = 27), those motivated by hearing restoration demonstrated poorer speech outcomes and datalogging. Conclusions: Improving overall hearing and restoring hearing to the deaf ear were the most common motivations for seeking SSD treatment. Adult CI recipients had similar motivations to those who chose non-surgical options. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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10 pages, 1356 KB

Open AccessArticle

Clinical Presentation of Hearing Loss After Contact with a Fish: Case Report

by Nina Rubicz, Harald Meimberg, Christina Rupprecht, Nikolaus Poier-Fabian, Ulla Folger-Buchegger and Paul Martin Zwittag

J. Clin. Med. 2025, 14(22), 8010; https://doi.org/10.3390/jcm14228010 - 12 Nov 2025

Viewed by 668

Abstract

Background: A 33-year-old pregnant woman experienced ear trauma from contact with a fish while swimming. Afterwards, the woman presented with vertigo and hearing loss. Methods: Clinical examination showed a foreign body (FB) in the middle and inner ear, which was removed surgically under general anesthesia. Postoperative care included antibiotics; the FB was sent to the lab for analysis. Results: Although vertigo resolved after surgical intervention, the woman continued to experience hearing loss and finally experienced deafness. Patient had an unusual mechanism of inner ear trauma. The FB was identified as part of a fish and determined to originate from a fish species of the genus Hemiramphus which is listed as harmless to humans in FishBase. Conclusions: As severe penetration of an FB into the middle and inner ear can lead to serious complications, removal of an FB from the ear requires special competence and should therefore only be performed by specifically skilled professional staff. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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7 pages, 445 KB

Open AccessCase Report

Rare Problems with Rotating Magnets in Cochlear Implants and How They Can Be Solved Without Surgery

by Lutz Gärtner, Martin Zimmerling, Cornelia Batsoulis and Anke Lesinski-Schiedat

J. Clin. Med. 2026, 15(9), 3384; https://doi.org/10.3390/jcm15093384 - 28 Apr 2026

Viewed by 287

Abstract

Objective: To report on a series of three cases in which problems with rotating magnets (blocked rotation, demagnetization) occurred in cochlear implants and to resolve these problems without surgical intervention. Methods: Of the 3635 devices with rotating magnets implanted at this tertiary referral hospital, 2 exhibited rotation blockage (associated with misalignment of the coil or audio processor), and 1 was partially demagnetized in a 1.5 T MRI scanner. Results: One blockage resolved spontaneously without intervention. The second blockage was resolved in the static field of a 3T MRI scanner, where the demagnetized magnet was also re-magnetized to its original strength. Surgical intervention or re-implantation was not necessary in either case. Conclusions: Surgical intervention or re-implantation is not primarily required in the event of problems with the rotating implant magnet. Prior to surgery, technical analysis can lead to a conservative solution. Full article

(This article belongs to the Special Issue Clinical Challenges and Innovations in Cochlear Implantation and Hearing Rehabilitation)

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