Why Do Candidates Forgo Cochlear Implantation?

Objective Identify barriers and facilitating factors in cochlear implant (CI) utilization by comparing functional measures between CI candidates who undergo or forgo implantation. Methods Forty‐three participants were separated into two groups: (1) 28 participants who underwent CI and (2) 15 participants who elected not to proceed with CI despite meeting eligibility criteria (no‐CI). Prior to implantation, all participants completed the CI Quality of Life (CIQOL)‐35 Profile and CIQOL‐Expectations instrument. They were also surveyed on factors contributing to their decision to either undergo or forgo CI. Word and speech recognition were determined using the Consonant‐Nucleus‐Consonant (CNC) and the AzBio tests, respectively. Results CIQOL‐Expectations scores were indistinguishable between groups, but there were substantial differences in baseline CIQOL‐35 Profile scores. Compared to the CI group, the no‐CI group exhibited higher pre‐CI scores in the Emotional (Cohen's d [95% CI] = 0.8 [0.1, 1.5]) and Entertainment (Cohen's d [95% CI] = 0.8 [0.1, 1.5]) domains. Survey data revealed that the most commonly reported barriers to pursuing CI in the no‐CI cohort were fear of surgical complications (85%), cost associated with implantation (85%), and perception that hearing was not poor enough for CI surgery (85%). Conclusions and Relevance The results of this study indicate that functional outcome expectations are similar between candidates who elect to receive or forgo CI, yet those who forgo CI have higher baseline CI‐specific QOL abilities. Level of Evidence 4 Laryngoscope , 133:3548–3553, 2023