What to do if patients aren't making adequate progress post CI? How do we define adequate progress? How often are you seeing patients post-op?
The University of Miami’s streamlined post-op cochlear implant (CI) protocol reduces adult visits to maximize access for new patients, relying on early ESRT-based programming and individualized success measures like wear time and word scores. Clinicians use judgment for additional follow-ups, ensuring patient care remains flexible and effective.
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Nov 25, 2024
What to do if patients aren't making adequate progress post CI? How do we define adequate progress? How often are you seeing patients post-op?
At the University of Miami, we follow a de-escalated post-op CI protocol where patients are seen at activation, 1 month, 3 month, and 12 months. We just recently cut out adult annual visits and recommend patients come back every 2 years at most. This has allowed us to open more appointment slots for new patients who need access to CI technology, and we have seen a significant increase in CI surgeries. The MSTB-3 provides a roadmap for other clinics to follow this same schedule. Pediatric patients require a few more consistent visits, and we follow the Pediatric MSTB for our little ones.
Some of you may wonder how in the world we are able to get by with so few post-op visits? The UM team believes in evidence-based practice, so we program with ESRTs by the 1-month appointment (for adults and children) which allows us to appropriately set CI stimulation levels early in the CI journey and to stick with the reduced appointment protocol. So far, clinicians and patients have been happy! Now of course there is always a patient (or 5) who will need to be seen more than this schedule allows. Clinicians should use their clinical judgement of when to bring patients in more often for programming. However, most patients are perfectly content NOT taking time out of work and daily activities to travel to the clinic.
Overall, we want to see patients progressing with their CI. But success can look different for each patient. Once we have achieved stable CI programming, our measures of “success” at UM are typically a combination of consistent wear time (>10 hrs/day), participation in a self-directed aural rehab program, improvement in English CNC or Spanish Bisyllabic word scores and patient reported outcomes. We try to counsel realistically pre-op so expectations are set appropriately on the front-end, however this does not always translate to a happy patient on the back-end. If reprogramming is needed we will bring the patient to clinic, but if patients are having problems with equipment or accessories, they are directed to the CI companies for assistance. The MSTB-3 really focuses on word scores for the CI ear, sentence scores for the everyday listening condition (maybe bimodal or bilateral), and questionnaires. I love that the MSTB-3 stresses the importance of looking at the WHOLE patient instead of simply a score.
