Candidacy for Cochlear implantation: Validating a novel Cochlear implant candidacy calculator against gold-standard, in-clinic audiometric assessments

Objectives: Cochlear implants (CI) are reliable implantable devices that are highly cost-effective in reducing the burden of hearing loss at an individual and societal scale. However, only 10% of CI candidates are aware of their candidacy and receive a CI. A web-based screening tool to assess CI candidacy may make many more individuals aware of their candidacy for cochlear implantation. The objective of this study was to validate and optimize the online Cochlear Implant Candidacy Calculator against in-clinic audiometric testing. Methods: Audiogram data and word discrimination scores for 132 patients who underwent initial CI consultation at the Johns Hopkins Cochlear Implant Center in 2020 were inputted into the calculator. Candidacy results from the calculator were compared against formal clinical diagnoses provided by the audiologist at the time of visit. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses were performed to identify optimal diagnostic thresholds. Results: Of the resulting 132 patients, 54 presented with single-sided deafness (SSD), and 114 were clinically determined to be CI candidates. ROC AUC analyses identified optimal thresholds of high-frequency PTA ≥65 dB and word discrimination score ≤ 50%. To maximize sensitivity at the expense of specificity, diagnostic thresholds of high-frequency PTA ≥ 65 dB and word discrimination score ≤ 70% were chosen, which yielded accuracy, sensitivity, specificity, and ROC AUC of 0.90, 0.94, 0.82, and 0.88, respectively. Conclusion: The novel online CI Candidacy Calculator exhibits high sensitivity and accuracy, and moderate specificity. The calculator may thereby be useful in increasing awareness of potential CI candidacy, increasing prevalence of CIs, and decreasing the burden of hearing loss.