Australia and New Zealand launch the first regional Living Guidelines for Adult Cochlear Implantation, setting a unified, evidence-informed framework to improve access, consistency and outcomes.
The Australia and New Zealand Hearing Health Collaborative (ANZ HHC) has unveiled Living Guidelines for Adult Cochlear Implantation, marking a pivotal moment for hearing healthcare in the region. Adapted from international living guidelines*, these are the first locally developed living guidelines for adult cochlear implantation in Australia and New Zealand. They aim to standardise care, improve access and enhance outcomes for adults living with hearing loss.
* adulthearing.com/living-guidelines
Global call to action
In 2021, the World Health Organization (WHO) called for global action to improve hearing care. In response, a global task force developed Living Guidelines for Cochlear Implantation in Adults – evidence-based, continuously updated recommendations to support best practice in screening, referral, evaluation and rehabilitation.
Why ANZ developed regional living guidelines
While Australian experts contributed to the original international living guidelines for cochlear implantation, the ANZ Hearing Health Collaborative identified a need for regional guidelines to address:
- Local health system differences
– Funding models, referral pathways and service delivery vary significantly across Australia and New Zealand. - Population-specific considerations
– Cultural and linguistic diversity, rural and remote access and Indigenous health priorities require tailored recommendations. - Regulatory and policy alignment
– Guidelines needed to reflect ANZ-specific standards, reimbursement frameworks and clinical governance requirements.
These factors meant that, while the international guidelines provided a strong foundation, a regional adaptation was essential to ensure practical implementation in ANZ contexts.
Local adaptation for ANZ
To ensure local relevance, the Australian and New Zealand Hearing Health Collaborative (ANZ HHC) – a network of over 70 stakeholders, including clinicians, researchers, consumer advocates, professional bodies and individuals with lived experience of hearing loss – undertook to adapt the Global Living Guidelines for the ANZ context.
Five structured workshops during 2023–2024 were held, focusing on referral pathways, evaluation protocols, candidacy criteria and outcome measures. Feedback from consumers and professional organisations informed the draft guidelines, which were released for public consultation before finalisation.
In mid-2025, the ANZ Living Guidelines for Adult Cochlear Implantation were finalised with 80% endorsement across clinical, consumer and professional stakeholders. These guidelines align with local service models and recommend timely referral for adults with severe or greater hearing loss who gain limited benefit from hearing aids. Candidacy is determined through multidisciplinary assessment involving audiological and medical/ENT input, and outcome measurement includes both objective performance and patient-reported outcomes.
Why it matters
Hearing loss affects millions of adults in ANZ, yet only a fraction of those who could benefit from assistive technologies – such as hearing aids and cochlear implants – actually receive them. This gap has profound implications for communication, mental health and social participation.
“This is about more than clinical practice – it’s about restoring connection, participation and wellbeing for thousands of adults,” said Dr Jaime Leigh, audiologist and ANZ HHC co-chair.
Professor Payal Mukherjee, ENT surgeon and co-chair, added: “This was a detailed and collaborative effort involving clinicians, academics and consumers. It sets a minimum standard of care and a starting point to drive change.”
These guidelines establish a unified, evidence-informed framework for cochlear implantation in adults across ANZ. They support improved access, consistency and quality of care, and offer a strong foundation for policy, funding and service planning. Implementation will be key to realising system-wide improvements in adult hearing healthcare.
What’s in the guidelines?
Adapted from the Global Living Guidelines, the ANZ version reflects local needs and clinical realities. Developed through national workshops and consensus among over 70 experts and consumers, the guidelines provide:
- Clear referral criteria for cochlear implant evaluation:
– Adults with moderate-to-severe hearing loss who gain limited benefit from hearing aids.
– Indicators include missing half or more of conversation, difficulty on the phone and reliance on lip-reading. - Comprehensive candidacy evaluation:
– Audiological, medical and psychosocial assessments.
– Imaging and ENT review for surgical planning. - Outcome measures:
– Patient-reported quality of life tools (e.g. CIQoL-35, LivCI, SSQ-12).
– Standardised speech perception and device performance checks. - Ongoing monitoring:
– Re-referral every 1–2 years, or sooner if hearing deteriorates.
The patient journey
The guidelines outline a continuum from screening at age 50, through referral, candidacy evaluation, surgery, device programming and lifelong rehabilitation. They emphasise person-centred care, multidisciplinary collaboration and the role of technology in maintaining communication.
“These guidelines are a major step forward in ensuring equitable access to hearing care,” said Professor Bamini Gopinath, Macquarie University and ANZ HHC Co-Chair. “They provide a clear, evidence-informed framework for clinicians, policymakers, and consumers alike.”
Call to action
Whether you’re a clinician, policymaker, or someone living with hearing loss, these guidelines offer a roadmap to better hearing health. Get involved: anzguidelines@adulthearing.com
Key referral criteria
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Moderate-to-severe hearing loss in either ear.
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Limited benefit from optimised hearing aids.
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Difficulty understanding speech in everyday settings.
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Missing half or more of conversation.
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Motivated to explore next steps with support.
Top 5 guideline highlights
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Screening starts at age 50 with simple self-report questions.
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Referral for CI evaluation if hearing levels are >=60db PTA and unaided speech perception score <=70% in any ear.
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Multidisciplinary candidacy assessment including ENT imaging and audiological tests.
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Outcome tracking with PROMs (CIQoL-35, LivCI, SSQ-12) and speech perception measures.
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Lifelong rehabilitation and device programming to optimise hearing and quality of life.
Accessing the guidelines
Full recommendations and evidence base:
Declaration of competing interests: Bamini Gopinath’s salary is co-funded by Cochlear Ltd.
