Reviewing the 60/60 referral criteria for cochlear implant candidacy evaluation in the Australian context.

OBJECTIVE

This study aimed to develop an Australian cochlear implant (CI) referral guideline, modelled on the 60/60 rule in the United States of America (USA), to suit local audiometric practices. The 60/60 rule was developed using US-specific candidacy criteria; in Australia speech tests and the unilateral status of hearing loss used to determine CI candidacy differ.

DESIGN

A retrospective review of adults referred for CI evaluation at a specialised CI clinic in Australia.

STUDY SAMPLE: Data of 1,141 adults were extracted, including unaided pure tone averages (3FAHL; average of thresholds at 0.5, 1, 2 kHz), and unaided and aided phoneme scores. CI candidacy was defined as aided CNC phoneme score ≤55% in either ear. Sensitivity and specificity were calculated for referral criteria variants.

RESULTS

Ninety-three percent had 3FAHL ≥60 dBHL and unaided phoneme score ≤80%. The best-performing criteria were: (1) 3FAHL ≥60 dBHL and unaided phoneme score ≤70% (sensitivity 87%, specificity 78%); (2) unaided phoneme score ≤60% alone (sensitivity 85%, specificity 80%), in either ear.

CONCLUSION

An Australian-adapted "60/70" rule (3FAHL ≥60 dBHL and unaided phoneme score ≤70%) in either ear is a simple guideline that provides clarity for local practitioners when to referring for CI candidacy evaluation.