A task force of 52 hearing experts has released new Living Guidelines for hearing care.1 The recommendations provide guidelines and guidance for hearing professionals to improve the standard of hearing care for adults.2 One of the nine recommendations states that if an adult has a hearing number ≥60 in their better ear* and difficulties with everyday speech understanding, they should be assessed for a cochlear implant.1

According to the team behind the Living Guidelines, this is a major step forward in clarifying the best hearing care for adults in.

“Clinical guidelines are integral to ensuring that healthcare decisions are based on the best available evidence. Before now, there were no international and patient-centred guidelines for hearing care and cochlear implants for adults.”

“This publication is a red flag to government policy-makers, insurance and funding bodies as well as health professionals to better understand the importance of providing accurate information and access to hearing healthcare for those who could benefit.”

According to the World Health Organization (WHO), the number of people living with hearing loss is set to reach 2.5 billion by 2050.2

Hearing loss has been linked to decreased quality of life, cognitive decline and depression3,4 and there is a growing body of evidence suggesting an association between hearing loss in older adults and neurocognitive disorders, such as dementia.5 Additionally, hearing loss can also have an impact on the individuals close to them, including family and friends.6

In the UK, most adults do not have their hearing assessed as part of regular health check-ups. Of those who receive hearing checks and find their hearing number is ≥60 dB HL, few are referred to a hearing specialist to assess whether cochlear implants could be the most beneficial treatment option.7,8

Despite the potential benefits of cochlear implants, less than one in 10 eligible adults will receive one in their lifetime.9

The new Living Guidelines make nine recommendations across hearing screening, specialist referral and evaluation, rehabilitation and patient outcomes. The two-year research project looked at more than 13,000 peer-reviewed studies and involved a panel of 52 experts representing 58 organisations, including those living with hearing loss. The guidance and guidelines will be updated as new evidence is published.

The Recommendations and Good Practice Statements are now open for public consultation and feedback from International Cochlear Implant Day, 25th February 2023, until 31st May 2023.

Meredith Holcomb AuD, Director, Hearing Implant Program, University of Miami Ear Institute and Co-Chair of the CI Taskforce said, “Millions of adults live with untreated significant hearing loss and often times an over the counter or prescription hearing aid simply cannot help them communicate effectively. Their ears reach a point where increasing the volume of sounds causes distortion instead of clarity. This is when a cochlear implant is necessary as it can bypass the damaged parts of the ear to allow for improved speech understanding.”

“People sometimes delay seeking treatment for hearing loss until they are struggling in their everyday life. Even when they do receive help, they may see multiple hearing healthcare providers in the same city and get different advice about their treatment options. Unfortunately, many are never told about the option and benefit of cochlear implants until their hearing is horribly bad.”

“With these guidelines, adults living with hearing loss and clinicians treating hearing loss will have consistent evidence-based advice about who should be tested and referred for a cochlear implant, and what standards of care they should go on to receive if they qualify.”

To have your say, visit the MAGICapp link HERE for the full guidelines, recommendations, and technical report. You can submit your comments using the feedback tab located under each recommendation in MAGICapp OR by downloading and using the submission template and emailing it to guidelines@htanalysts.com.au.

Please note you need to sign into MAGICapp to leave a comment and these comments will be public. If using the submission template, the feedback, identifiable information will only be visible to the administrator and remain anonymous. All feedback will be considered by the Task Force, to support their evaluation of the recommendations and good practice statements included in the guidelines.


  1. Cochlear Implant Task Force. Improving the standard of care for adults with hearing loss and the role of cochlear implantation: Living Guidelines. Available at https://app.magicapp.org/#/guideline/6719. Accessed 25th Feb 2023.
  2. World report on hearing. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.S
  3. Gates GA, Cobb JL, Linn RT, Rees T., Wolf PA, Agostino RB. Central auditory dysfunction, cognitive dysfunction, and dementia in older people. Arch Otolaryngol Head Neck Surg 1996;122(2):161-7.
  4. Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and Management of Adult Hearing Loss in Primary CareScientific Review. JAMA 2003;289(15):1976-85.
  5. Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. : Hearing loss and incident dementia. Arch Neurol 2011;68(2):214-20.
  6. Völter C, Götze L, Ballasch I, Harbert L, Dazert S, Thomas JP. Third-party disability in cochlear implant users. 2021
  7. Buchman CA et al. Unilateral Cochlear Implants for Bilateral Severe, Profound, or Moderate Sloping to Profound Sensorineural Hearing Loss. JAMA Otolaryngology 2020; 146(10):942-53.
  8. Sorkin DL. Access to cochlear implantation. Cochlear Implants Int 2013 Mar;14 Suppl 1(Suppl 1):S1. doi: 10.1179/1467010013Z.00000000081.
  9. Carlson ML. Cochlear Implantation in Adults. The New England journal of medicine 2020;382(16):1531-42.
  10. Zwolan TA, Schvartz-Leyzac KC, Pleasant T. Development of a 60/60 Guideline for Referring Adults for a Traditional Cochlear Implant Candidacy Evaluation. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2020;41(7):895-900.

*An adult with any level of hearing loss should be referred for cochlear implant evaluation if they meet the cochlear implant eligibility criteria of three frequency (500, 1000, 2000 Hz) pure-tone average (PTA) in the better ear that is equal to or greater than 60 dBHL (decibels hearing level), AND expresses difficulties with speech understanding in their everyday environment.6 Any adult that meets the above cochlear implant eligibility criteria should be referred to a cochlear implant specialist for a complete cochlear implant evaluation and preoperative assessment.