Australia has an enviable reputation for innovation in hearing health. We are the birthplace of the multichannel cochlear implant, home to the internationally respected Australian Hearing Hub, and an agenda-setting research and industry leader.

Our newborn hearing screening program is globally recognised, and children have clear pathways to addressing their hearing loss, including through hearing aids and cochlear implants. We know, for example, that around 90% of children who are eligible for a cochlear implant will receive one.¹

But where we – and many other countries – fall down is in awareness around adult hearing loss. And more specifically, connecting adults with severe hearing loss to that very innovation designed right here – the multichannel cochlear implant.

The potential to change adult lives through cochlear implantation is enormous. Reaching them though, is another matter. Cochlear implants aren’t for everyone, but there is a large, underserved population for whom they are the right solution. Only about one in 10 adults who could benefit from implants currently access them.²

So, what’s the problem? Why the vast gap between children and adults when it comes to cochlear implants? As we celebrate International Cochlear Implant Day it’s a timely question to ask.

Barriers to uptake

The first hurdle is something hearing practitioners know all too well – the stigma that still surrounds adult hearing loss. We know that on average it takes nine years for someone to act once they know they have a hearing issue. Hearing loss is still considered as ‘just a part of getting older’. It can also creep up on you, dampening the imperative to act.

All the while, the negative impact on people’s health and wellbeing continues to grow. Social isolation, mental health problems, falls, and cognitive decline – all have known associations with unaddressed hearing loss.

But when it comes to considering cochlear implants, there are additional barriers. A growing body of evidence, including from Australia³, gives us important insights into why people might be hesitant.

The most common barriers patients report are fear of surgery and potential complications, such as losing residual hearing, uncertainty about the outcome given the procedure is not reversible, and concerns around how the device might perform.

Those of working age are worried about taking time away from their job and what the process of rehabilitation might involve. And they report concern with being able to access the surgery and rehab, particularly if they live in regional or rural areas.

A recent review⁴ of the evidence around barriers to cochlear implant uptake argues that as a field, we are disproportionately implanting more Caucasians and those from higher income groups.

Collaborations needed to pull together

It also highlights the important role that healthcare providers play in helping people who might benefit from implants get access to the right information. Having a healthcare provider who isn’t supportive or knowledgeable about implants and who to refer to, has also been found to be a major barrier to uptake.

So, what do healthcare providers, such as GPs and audiologists say? A study led by Australian researchers at Macquarie University found that a lack of support to help them identify candidates and refer them for assessment, and limited access to information and resources were the most common roadblocks. The lack of continuity of care and coordinated services in rural areas were also nominated as key hurdles.

Other factors include being concerned that repeatedly raising implants as an option might disengage their patients, perceiving implants as being more relevant for children, limited tertiary training around CI and limited opportunities for shared care.

Tackling this long list of issues seems daunting. The good news is we have a clear evidence base to guide us on where to focus our energies as a sector.

There’s no single solution. That’s why we need strong collaborations across service delivery, industry, government and academia. Pulling together gives us our best shot at helping people understand that taking action on hearing loss is worth it, whatever your age.

With strong dialogue we’ll drive new ideas to empower adults with the knowledge they need to explore the pathways and options available to them. Implants are now a much more likely option for people with single-sided deafness and the field is advancing rapidly. But so is the need for new approaches.

With the number of Australians with hearing loss expected to double by 2060 and the huge financial and social costs associated with that, we have all the motivation we need to drive change.

This article was originally featured by Hearing Practitioner Australia. Read it on their site here.

How cochlear implant technology has evolved

Check out the short video below, which shows how far cochlear implant technology has come.

References

1. Audiology Australia, Australian College of Audiology, Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS), Better Hearing Australia, CICADA Australia Inc, CICADA Queensland, Cochlear Ltd., Independent Audiologists Australia. 2020-2021 Pre-Budget Submission Keeping Senior Hearing Implant Users Connected https://treasury.gov.au/sites/...
2. Access Economics (2006). Listen Hear. The Economic Impact and Cost of Hearing Loss in Australia. https://www.deafnessforum.org....
3. Bierbaum, M., McMahon, C., Hughes, S., Boisvert, I., Lau, A., Braithwaite, J., & Rapport, F. (2020). Barriers and facilitators to cochlear implant uptake in Australia and the United Kingdom. Ear and Hearing, 41(2), 374-385. https://doi.org/10.1097/AUD.0000000000000762
4. Neukam, JD., Kunnath, AJ., Patro, A., Gifford, RH., Haynes, DS., Moberly, AC., Tamati, TN. (2024). Barriers to Cochlear Implant Uptake in Adults: A Scoping Review. Otology & Neurotology, 45(10):p e679-e686. https://doi.org/10.1097/MAO.0000000000004340