Cochlear implant programming: a global survey on the state of the art

The programming of cochlear implants (CI) is essential for good performance. However, to date still no commonly accepted Good Clinical Practice guidelines exist. This paper reports on the results of an exhaustive inventory of the current practice worldwide. A questionnaire on current practices was distributed to CI centers worldwide.The results were discussed during an international debate and checked and verified by means of individual interviews during the months after the debate. In addition all centers were invited to participate in a cross-sectional study logging the details of 5 consecutive CI fitting sessions in 5 different CI recipients. Descriptive statistics are used to present the results in terms of 5 parameters (median, quartiles, and extremes), histograms, and box and whisker plots. Forty-seven CI centers filled out the questionnaire. All together they follow 47600 CI recipients in 17 countries and 5 continents. Sixty-two percent of the results were double-checked by individual interviews and 72% of the centers returned the cross-sectional data for verification. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing.Themain focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and extrapolated for the others. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone audiometry and speech audiometry. Objectivemeasures play a small role as indication of the globalMAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice.