Our 8,000th cochlear implant recipient heard for the first time, recently.

Five-month-old Julian was the fifth member of his family to access sound through this incredible technology, marking a major milestone for NextSense - which runs Australia’s largest cochlear implant program - and for the sector as whole.

As an audiologist for over 20 years, it has been fascinating to watch the evolution of cochlear implants over the course of my career. What was initially a niche device used in very limited circumstances, has become a commonly accepted solution for people of all ages with moderate-to-profound hearing loss in one or both ears.

But only about 10 per cent of adults who could benefit from a cochlear implant receive one. There remains a significant unmet need.

One in three people over the age of 65 are affected by hearing loss, which has been identified as one of the modifiable risk factors associated with dementia .

A cochlear implant provides access to high quality, detailed sound by stimulating the hearing nerve directly, bypassing damaged parts of the inner ear.

While there is good uptake of cochlear implants for children in Australia, uptake remains poor among our adult population , despite it being a potential solution for people of all ages.

NextSense cochlear implant clients range from age three months to over 90 years at the time of surgery, with many in between. But barriers exist, including around awareness that they are an option for all ages.

When to refer for cochlear implant candidacy assessment

Acting early is crucial. Recommended clinical pathways for anyone diagnosed with significant hearing loss encourage early referral for evaluation of cochlear implant candidacy to maximise speech recognition after implantation.

To help determine if a client is a strong candidate for referral for a cochlear implant, try to understand from them and/or their significant other whether they are struggling to hear everyday speech, the television or people on the phone with hearing aids, or they find themselves withdrawing from social events.

When testing, a pure tone average of greater than or equal to 60dBHL is also a good indicator for referral. Once our team has received a referral, they meet with the candidate to understand more about their hearing loss, in addition to their listening and communication needs and goals with a cochlear implant. These factors, along with personal circumstances, general health and desired outcomes help determine if an implant is a suitable option.

A comprehensive assessment considers results from audiograms, speech perception testing, functional questionnaires, imaging, vestibular tests, the goals and expectations of the client, and an assessment of medical fitness for surgery.

Ensuring an exceptional model of care

The hearing journey for cochlear implant recipients does not end at device switch-on. It is essential to have access to tailored, ongoing care and wraparound support, whatever the client’s age.

Key to this is incorporating a coordinated team approach with the client and their family at the centre of the ecosystem of care. The approach incorporates strict evidence-based clinical processes, including for mapping and verification, rehabilitation, and ongoing monitoring and assessment. Providing ongoing training to staff and having strong systems in place to capture data are also vital.

Working together to advance hearing care

By working together as healthcare professionals, we can ensure more people who could benefit from cochlear implant technology are aware it is an option. To help them reconnect with their loved ones and interests and feel more confident participating in everyday activities - and ultimately help them live life to the fullest.

This article was originally featured in ACCORD Magazine. You can read it on their website here.

References

1. Eikelboom RH et al (2025). Cochlear Implantation in Australia: A Retrospective Analysis of 23 Years of Activity. Clinical Otolaryngology, 50(5):871-877. https://doi.org/10.1111/coa.14...
2. Livingston G et al (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404 (10452): 572 – 628. https://www.thelancet.com/jour...(24)01296-0/abstract#%20
3. Eikelboom RH et al (2025). Cochlear Implantation in Australia: A Retrospective Analysis of 23 Years of Activity. Clin Otolaryngol, 50(5):871-877. https://doi.org/10.1111/coa.14...
4. Buchman CA, Gifford RH, Haynes DS, et al. (2020). Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements. JAMA Otolaryngology-Head & Neck Surgery, 146(10):942–953. https://doi.org/10.1001/jamaot...