Equitable access to cochlear implants: An application development award to underpin an evaluative trial of optimised hearing tests

Background: Compared to hearing aids, cochlear implants can improve quality of life, mental health, employability, and communication with family, friends, and health professionals for adults with severe to profound hearing loss, but coverage is low and inequitable. Many patients and audiologists dislike the speech-based hearing test used to determine candidacy because i) patients who do not speak fluent English are more likely to fail, meaning they are at greater risk of ineffective surgery and ii) it uses a deep, over-articulated, loud voice in quiet, not reflecting real life. Candidacy hearing tests need to be more acceptable, sensitive, specific, and identify candidates in an equitable way. Aim: Carry out underpinning development work to support an NIHR application to develop and trial optimised hearing test(s) for cochlear implant candidacy. Methods: Three independent, complementary workstreams: 1. Synthesise the evidence base for voice characteristics needed in optimised hearing tests via a systematic review, to inform the tests used in the subsequent project. Map the hearing tests used in the UK, analysing their acoustic properties (voice pitch, intonation, duration/speech rate, level, background noise) and characterise them in terms of objective speech-intelligibility metrics, language, and language-dependence, to identify any need to develop new tests in the subsequent project. 2. Patient and public involvement of diverse groups, using culturally appropriate, tailored deaf communication tactics, into subsequent study design. With bilingual Research Champions at the Race Equality Network in Bradford (a city of ethnic diversity and high deprivation) we will consult 30 adults with hearing loss who are not fluent in English and span a range of ethnicities. We will also form and consult with a group of fluent English speakers who either have an implant or were denied one due to their speech-based hearing test results. 3: Consult a network of stakeholders, using and expanding on our contacts in professional bodies, patient support groups, charities, clinics, research, and NHS leadership. We will consult via workshops, surveys, and online meetings on the research questions the subsequent study should address and how, to inform future National Institute for Health and Care Excellence guidance on adult implant candidacy. Synthesising results across workstreams will lead to a future project protocol underpinned by a solid evidence base, asking questions important to patients and clinicians in an acceptable way, and deliverable in the NHS. Timelines: The application development award work will be delivered in 12 months. The application for funding for the subsequent trial will be completed within 3 months of the development project conclusion. Anticipated impact and dissemination: Delivering within a team that has diverse specialist skills will develop the main applicant toward research independence. A strong bid for NIHR funding for hearing test development and a multi-site observational trial will be produced. This trial will reveal optimal cochlear implant candidacy hearing tests to rapidly translate into clinical practice, targeting healthcare funds more effectively at those most likely to gain real-life benefit. Results will be shared via NIHR platforms, conferences, peer-reviewed journals, magazines and accessible reports and video summaries to clinicians and members of the public via users groups, charities, and professional bodies.