Comparison of In-Person Versus Remote Cochlear Implant Candidacy Evaluations

In Aim 1, participants (N=42) will receive both an in-person (standard of care) and remote
(experimental) comprehensive audiological evaluation.Participants will be randomized to
receive both sessions in a particular sequence (in-person, remote versus remote, in-person)
to reduce order effect. Remote audiological sessions will involve face-to-face communication
and testing over a high-speed hard wired connection (10 Mgb/s) conducted within the
University of Kentucky firewall protection using a Polycom 500 series teleconference audio
and live video set-up. The audiologist will direct the remote audiological evaluation with
the participant (in the UK Otolaryngology (ENT) practice in Morehead, KY) from a work station
at the Otolaryngology (ENT) practice in Lexington, KY. Evaluations will include pure-tone air
and bone conduction thresholds (level of hearing ability) along with speech audiometry
(speech recognition thresholds and word recognition scores). Scores from the Arizona
Biological (AzBio) test (speech recognition) completed remotely and in-person will be
compared for each person to determine equivalence. Upon enrollment, participants will fill
out a demographic questionnaire along with an adapted version of the University of Rhode
Island Change Assessment (URICA) questionnaire, assessing their current stage of change
toward seeking hearing rehabilitation.

Aim 2 will involve participants from Aim 1 (N=12). Half of the cohort (n=6) will be
randomized to receive a remote cochlear implant counseling session (experimental) and the
other half (n=6) will be randomized to receive an in-person cochlear implant counseling
session (standard of care). Both sessions will occur in the ENT practice in Morehead, KY with
an audiologist but the audiologist will be physically located in the ENT practice in
Lexington, KY directing the session during the remote sessions. The counseling session lasts
30-45 minutes and consists of 5 key components: an explanation of the patient's hearing
testing results, a discussion of the impact of hearing loss on the patient's life, treatment
options for hearing loss including hearing aid amplification and cochlear implantation, an
explanation of how cochlear implants function and the necessary steps in candidacy and
rehabilitation, and an outline of the expected outcomes following cochlear implantation.
After participants receive either remote or in-person session, they will complete a
satisfaction questionnaire on the session and the URICA questionnaire.The URICA questionnaire
is a validated assessment tool measuring an individuals' motivation for change by providing a
score that places them within one of the four categories: precontemplation, contemplation,
action and maintenance (Laplante-Lavesque, Hickson, & Worral, 2013). After each session, the
audiologist will fill out a satisfaction questionnaire.

Inclusion Criteria:

1. Adults (>18) who are current patients at the University of Kentucky Morehead Clinic

2. Adults who have moderate to profound hearing loss

3. Adults who can speak and understand English since cochlear implantation candidacy
testing is performed using standardized word lists in English

Exclusion Criteria:

1. Adults with prelingual deafness

2. Adults who use sign language as a primary means of communication

3. Adults with active otological infections with otorrhea or cerumen impaction seen on
otoscopy

4. Pregnant women since pregnant women are not cochlear implant surgical candidates