Simplifying the switch on
Reviewed by Sirat Lodhi

The pandemic forced a sudden shift towards telemedicine, prompting many within the field to anticipate a permanent digital platform for audiology clinics. While some clinical hesitation regarding remote care persists among practitioners, the technical capabilities of digital health infrastructure are rapidly evolving to support safe, virtual interventions. This quality improvement case study evaluates a remote cochlear implant pathway designed for isolated, northern Canadian communities. Utilising remote desktop software alongside on-site facilitators, a tertiary implant centre successfully conducted candidacy evaluations, comprehensive speech perception testing, and initial switch-ons for five adults without an audiologist present in the room. The concept of remote activation represents a significant departure from standard practice. The initial switch-on is traditionally regarded as a critical milestone requiring face-to-face care to manage patient anxiety, processor fitting and immediate programming feedback loops. However, this study directly challenges that conventional view, reporting high patient satisfaction alongside zero adverse events. From my perspective as a surgical trainee navigating the NHS, these international findings are highly translatable to our own domestic deficits in care. Adult cochlear implantation remains severely underutilised within the UK. While historical clinical benchmarks indicate an overall lifetime uptake of only approximately 5% among eligible adults, recent national audit data highlights that the bottleneck begins early: just 9.7% of clinically eligible candidates are ever successfully referred for an assessment. Although the UK lacks the extreme geographical isolation of polar regions, inadequate rural transport links and long outpatient clinic backlogs are real barriers to equitable care. Mitigating the travel burden for isolated patients by delivering programming sessions closer to home could improve long-term utilisation. Crucially, this study shifts the professional dialogue from whether we should use telehealth, to how far its boundaries can be safely extended.

Remote cochlear implant candidacy assessment, activation and speech perception testing in northern communities: a quality improvement case study. 
Ng AHC, Banh J, Le T, et al. 
COCHLEAR IMPLANTS INT 
2026; Epub ahead of print.