Cochlear implant referral criteria

Did you know that approximately 1 in 20 adults who could benefit from a cochlear implant have them?1,2 If hearing aid technology is not providing your patients the ability to hear and understand speech, a cochlear implant may be the next step.


A cochlear implant may be the next step for your patient

Many adults with hearing loss are not receiving cochlear implants even though they would benefit from them.3 Conservative industry estimates suggest that no more than 1 in 20 adults who could benefit from a cochlear implant have one.1,2 Under-provision leads to a substantial unnecessary burden to the individual with hearing loss, leading to a poorer quality of life;1 it may also have economic and social consequences.4-6 There are many reasons contributing to this under-provision, including low awareness of the benefits of cochlear implants among healthcare professionals and individuals with SNHL, as well as a lack of specific medical referral pathways.3

Traditionally, cochlear implants have been considered a treatment option as a last resort and only for those who have lost all of their hearing. Health benefits and improved hearing outcomes7 support the need to shorten the duration of hearing loss and consider cochlear implantation before hearing loss progresses to profound. A recent study showed that 95% of patients who met traditional indications for a cochlear implant (n=25) had a pure-tone average that was greater than or equal to 60dB, while 92% had a better ear unaided monosyllabic word score that was less than or equal to 60%.8 Therefore, patients with hearing losses greater than or equal to 60 dB HL (pure tone average 0.5, 1k, 2kHz) and speech understanding less than or equal to 60%,8 should be considered for a referral for a cochlear implant evaluation.

96% patients that meet the 60/60 criteria were cochlear implant candidates8

When to consider a cochlear implant evaluation for adults*

If your patient meets ANY of the criteria below, consider referring the patient for a full cochlear implant evaluation to determine candidacy.*

FUN3498 ISS5 FEB22 CI Criteria Magnet TP (2).pdf

Referral resources

To help keep medical referral guidelines top of mind as you see patients, we offer referral guideline magnets and pocket guides. The referral guideline magnet is a great resource to hang in your office or sound booth and the pocket card is small enough to fit in your pocket. If you would like to place an order, please email or download the PDF versions below.

Download Magnet PDF  Download Pocket Guide PDF


How to Counsel Referral Patients

Another great resource is our 'How to Counsel Referral Patients' guide. This guide is great to have sitting on your desk to walk potential candidates through the cochlear implant process. If you would like to place an order, please email or download the PDF version below.

'How to Counsel Referral Patients' guide

1.2MB | PDF

Download now

Did you know?

Many adult cochlear implant users continue to wear a hearing aid on their non-implanted ear, commonly referred to as bimodal hearing. A recent study reported that 95% of patients were satisfied with their bimodal hearing solution, when only 9% of the same group reported satisfaction with their bilateral hearing aid solution.9

Learn more about the longitudinal outcomes of cochlear implantation and bimodal hearing.

Learn more

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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

For a full list of Cochlear’s trademarks, please visit our Terms of Use page.

*This provides a recommendation of when an adult may be referred for a cochlear implant evaluation, but does not guarantee candidacy based on indications. For the approved Cochlear Nucleus Indications, please refer to the important information booklet or physician’s guides.


  1. Sorkin DL. Cochlear implantation in the world’s largest medical device market: utilization and awareness of cochlear implants in the United States. Cochlear Implants Int 2013; 14 (Suppl 1):S4– 12.
  2. De Raeve L. Cochlear implants in Belgium: Prevalence in paediatric and adult cochlear implantation. Eur Ann Otorhinolaryngol Head Neck Dis 2016;133(Suppl 1):S57–60.
  3. Mahboubi H. Gaps in evaluating, managing hearing difficulties. Hearing Journal 2018;71(3):6.
  4. Woodcock K, Pole JD. Educational attainment, labour force status and injury: a comparison of Canadians with and without deafness and hearing loss. Int J Rehabil Res 2008;31(4):297–304.
  5. Sung YK, Li L, Blake C, Betz J, Lin FR. Association of hearing loss and loneliness in older adults. J Aging Health 2016;28:979–94.
  6. Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg 2014;150:378–84.
  7. Derinsu U, Yüksel M, Geçici CR, Çiprut A, Akdeniz E. Effects of residual speech and auditory deprivation on speech perception of adult cochlear implant recipients. Auris Nasus Larynx. 2019 Feb;46(1):58-63. doi: 10.1016/j.anl.2018.06.006. Epub 2018 Jun 23. PMID: 29945747.
  8. Zwolan TA, Schvartz-Leyzac KC, Pleasant T. Development of a 60/60 guideline for referring adults for a traditional Cochlear implant candidacy evaluation. Otol Neurotol 2020;41:895-900.
  9. Lupo JE, Biever A, Kelsall DC. Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation. Am J Otolaryngol. 2020;41(2):102300. doi:10.1016/j.amjoto.2019.102300