Enhancing Cochlear Implant Outcomes with Remote Aftercare – Discussion with Sandra Porps, AuD

Hello,

and welcome to another episode

of this Week in Hearing.

I’m Brian Taylor.

Our topic this week is the use

of remote aftercare services for

cochlear implant patients.

Here to discuss this important

topic in a new study that looks

at remote care with these

patients is clinical

audiologist dr.

Sandra Porps of the Michigan

Ear Institute.

Welcome to this week in Hearing.

Sandra,

it’s great to have you with us.

Thank you so much for having me,

Brian.

I’m really looking forward

to our talk today. Yeah,

I guess before we get started,

let’s kick things off by having

you tell our audience a little

bit about yourself and your role

at the Michigan Ear Institute.

Great. Well, I live in Michigan.

I’m from Wisconsin originally.

So Midwest.

I did my undergrad work at

Marquette University

in Milwaukee,

and then I did my graduate

work at Central Michigan.

I did my fourth year at Michigan

Ear Institute,

and I have stayed on ever since

for about almost 18 years now.

So I am a clinical audiologist,

and then now I work primarily

with cochlear implant patients.

Great.

And that’s why we had you on the

show today to talk about

cochlear implant patients and

your expertise in that area.

My first question for you,

Sandra,

is I read recently that there

are only about 5% of the more

than about 2 million adults who

are potential candidates for

cochlear implant technology have

actually been treated.

That number seems really low 5%

at potentially 2 million.

Can you tell us a little bit

why that population is

so undertreated?

Yes,

it makes me sad, too.

There’s a lot of factors.

So accessibility is a huge one.

If you look at our study we

dropped and which we’ll get

into, which we’ll talk about,

but the number of visits

required in that first year,

that could be time off work,

that could be travel time,

that could be a loved

one’s time off work.

So accessibility in terms of

time is certainly a

big part of it.

Accessibility in terms

of centers.

There are some areas like

Michigan where I am,

where we have a lot of really

great cochlear implant centers.

But then there are some of my

colleagues out in the west where

my colleague might live in

Colorado but might have to drive

to Wyoming to get treatment

for some of these people.

So that’s certainly part of it

as well. And then the referrals,

a lot of physicians might not

know what the current criteria

is that their patients really

can get cochlear implants

a lot earlier.

Now with the expanded Medicare

access last fall than they

were previously.

So Medicare previously the

criteria was you had to score

40% or less on sentence testing.

Now it’s 60% or less.

So that criteria has

been expanded,

which opens cochlear

implantation up to

even more people.

But we just have to get the word

out to physicians and other

referral center that your

patients can be helped a lot

sooner than you think they can.

Yeah, and I know.

Audiologists are still

unfamiliar with the new criteria

candidacy requirements.

So it’s good to get the word

out. And actually,

we’ve had other guests on This

Week in Hearing recently that

have talked in detail about the

60 by 60 requirements that are

new, which is wonderful. Yeah,

I agree.

Getting the word out there

is so important,

and I thank you for the work

that you do to do that.

Well,

before we talk about your study,

I think it would be helpful if

you could kind of give us a

little context around the

traditional sequence of

appointments for adults who are

cochlear implant wearers. Yes.

So traditionally there’s a

number of appointments in that

first year at our own center,

Michigan Ear,

prior to this study,

you had your activation

appointment,

then you had follow ups at one

week, two week, and three weeks.

Then you had a follow up a month

later, then three months later,

then six months later,

and eventually once a year.

So that was a whole lot

in that first year.

And that was a big commitment

for our patients to commit to,

I would imagine.

Especially if you’re driving any

more than even and a half an

hour. That’s a big burden.

Well,

and you don’t think about

Michigan being a very large

state, but it is.

At Michigan Ear Institute,

over 50% of our patients have

a three hour plus drive.

Yeah.

So that’s a big time commitment

for all that follow up care.

Well,

let’s talk about your study.

I know that you’re the lead

author on a recently published

multicenter study that looks

at a better way to care for

patients after implantation.

So tell us a little bit about

the study and what you found.

Sure.

So I got to be author of this

paper with some wonderful

colleagues.

There were five audiologists

that participated across three

centers, us in Michigan,

and then two in Texas.

And what we did is taking that

very extensive model of so

many follow up visits.

In the first year,

we shortened that down

to four visits.

So you have activation one

month, three month,

and then six month,

and then annual as needed.

So that took that from a number

of visits down to four,

which is a lot easier for

our patients. Great.

And so what did you find

in your study? Like,

did the patients benefit from

the remote options?

Were the outcomes different?

Tell us more about what you

found. So in the findings,

there’s a number of things

that we found.

The first was we look

at audiologically.

How are these patients hearing

compared to their traditional

counterparts?

Because if they were delayed

in their hearing abilities,

if they weren’t reaching

those same milestones,

then this would not

be effective.

And we found that at three

months and six months,

they were meeting their

hearing milestones.

They were scoring very,

very similarly to patients that

underwent the traditional model.

So that was great.

The second part was how happy

are they overall with their

hearing? And they’re very happy.

Again scored very similarly to

the patients that went through

traditional model and the last

is their service were they happy

with the service they received?

And 14 out of 14 subjects that

underwent the full that stayed

with us throughout

the full trial.

They all rated their services

excellent, which was fantastic.

We were very happy to see that.

Yeah,

those are fantastic outcomes.

And for those that want

to read the study,

there’ll be a link in the show

notes to where that study

was published.

I think it was just published

a few months ago,

if I’m not mistaken. Right?

Yes,

in Cochlear Implants

International,

which was very nice. Well,

as we wrap things up here,

could you maybe share with us,

given your 18 years of

experience with this population,

what are some things that other

hearing care professionals

really need to know about remote

CI aftercare cochlear

implant candidacy?

What insights might you want

to share with our audience?

One of the parts of this study

was embracing the remote

care through Cochlear.

You can have remote visits

either via remote assist

with your audiologist.

You can have remote checks

via your Cochlear app,

and you can also have visits

with the recipient

support manager.

And I know at first when

we started this,

we weren’t really sure that this

population was going

to embrace that,

and I found quite the

opposite was true.

They absolutely embraced

the remote options.

And in many ways,

I feel much closer

to my patients,

being that I could see

into their world.

And doing a remote assist

appointment, for example,

I can see their living room.

I can see where are you sitting,

where’s your spouse sitting when

you’re trying to watch TV.

And being able to do this

together really helped give

realistic expectations and help

the counseling aspect.

When I start talking with my

patients about using

remote options,

the first question

I always say is,

have you ever done a FaceTime

video with your grandkids or

your kids? And when they say,

oh, yes,

we do that all the time.

If you can do a FaceTime video,

you can do a remote session,

whether that is with your

audiologist or with the

recipient support manager,

you can do any of the

remote tools.

If you can do a FaceTime video,

well,

that’s really interesting and

great to know that if you

make it available,

let people know that that remote

care is an option,

that they tend to embrace it.

I think that’s a lesson for all

hearing care professionals

out there. Yes,

it’s been a great journey.

Well,

thank you so much for spending

time with us.

This is great information.

And like I said,

there’ll be a link in the show

notes to the study that you

were the lead author on.

And again,

our guest today clinical

audiologist, dr.

Sandra Porps of the Michigan

Ear Institute.

Thank you so much for your

time and your expertise.

Thank you so much for having me.