The literature across a 35-year time span highlights disproportionately low rates of cochlear implantation among adults compared to paediatric populations, despite the significant benefits of cochlear implants (CIs) for individuals with severe to profound hearing loss. Barriers span psychological, informational, systemic and social concerns. Authors identified 95 patient-related barriers, with 4 main themes as pervasive barriers to CI for adults: 1. Uncertainties, fears and beliefs: Psychological barriers such as fear of surgery, concerns about losing residual hearing, negative expectations about CI outcomes, stigma and misconceptions about the effectiveness of CIs. 2. Knowledge and professional guidance: Limited awareness and support from healthcare professionals, lack of structured adult hearing screening programmes and insufficient patient knowledge about CIs. 3. System and organisational factors: Financial concerns, fragmented funding systems, limited access to CI services and systemic requirements like hearing aid fitting before CI candidacy evaluation. 4. Psychosocial and practical support: Challenges with travel, time commitments, appointment scheduling and limited family or social support. The review emphasises the need for coordinated strategies to address these barriers, including improved education for healthcare professionals, clearer communication about funding options, standardised hearing screening programmes and the integration of telehealth services to reduce logistical burdens. It also calls for targeted interventions to address psychological and social barriers, such as preoperative patient information counselling, peer and professional support networks. Concluding remarks suggest that addressing these barriers requires a system-wide approach. An approach that would improve access, equity and timely uptake of cochlear implantation among adults. It is suggested that future research efforts should focus on interventions to reduce patient anxiety, improve education and streamline service delivery to support professionals and patients.
Patient barriers: adult cochlear implantation systematic review
Reviewed by Charlotte Rogers
Patient barriers to adult cochlear implantation: a systematic review of literature.
CONTRIBUTOR
Charlotte Rogers
BSc Healthcare Science (Audiology), Allied Health Sciences, De Montfort University, Leicester.
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