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​The Use of Distance Technology in Cochlear Implant Service Delivery

Many clinical visits are necessary in the process of obtaining a cochlear implant. In addition to several pre-implant appointments, cochlear implant recipients will return to the clinic for as many as 7-10 visits over the first year following implantation, and 1-2 visits per year thereafter. Children might also have supplemental visits for speech, language, and listening therapy. Additional visits may be necessary if problems arise that require device troubleshooting, reprogramming of the speech processor, or additional testing.

In sparsely populated regions such as the Midwest, numerous visits to a specialty clinic can be burdensome for families. Traveling extensive distances can cost significant amounts of time and money. Patients might be limited in other ways, including lack of transportation or being physically unable to travel. In recent years, there has been increased interest in using distance technology or “telepractice” to increase patients’ accessibility to specialty cochlear implant services. The term “telepractice” refers to the use of technology to deliver health-related services when the patient and provider are separated by some distance. The specific type of technology that is used can vary, but might include the telephone, videoconferencing equipment, web cameras, and/or the Internet.

Several disciplines have been using telepractice for years. These include nurses (e.g., diabetes education), physicians, psychologists (e.g., counseling), and social workers. Professionals in these four disciplines have been designated by the Centers for Medicare and Medicaid Services (CMS) as eligible telepractice service providers. Because many private insurance carriers follow CMS policies, it can be difficult for care providers in other professions (such as speech-language pathology or audiology) to be reimbursed for services provided via telepractice. This problem has limited the widespread use of telepractice for cochlear implant related services. However, some states have implemented mandates to ensure reimbursement for other clinical services delivered via telepractice1.

In recent years several researchers, including a team at Boys Town National Research Hospital2-4, have conducted studies to determine whether cochlear implant services delivered via telepractice are equivalent to those delivered in the traditional face-to-face setting. Outcomes from these studies suggest that telepractice is a viable alternative for cochlear implant service delivery. However, more work is needed to evaluate the feasibility of providing clinical services via telepractice for children with cochlear implants.


  1. 1. Brannon, J. A. & Brown, J. (2012, October 09). Bottom Line: Telepractice Reimbursement on the Rise. The ASHA Leader. Retrieved December 14, 2012 from
  2. 2. Goehring, J. L., Hughes, M. L., & Baudhuin, J. L. (2012). Evaluating the feasibility of using remote technology for cochlear implants. The Volta Review, 112(3),255-265.
  3. 3. Goehring, J. L., Hughes, M. L., Baudhuin, J. L., Valente, D. L., McCreery, R. W., Diaz, G. R., Sanford, T., & Harpster, R. (2012). The effect of technology and testing environment on speech perception using telehealth with cochlear implant recipients. Journal of Speech, Language, and Hearing Research, 55(5) 1373-1386.
  4. 4. Hughes, M. L., Goehring, J. L., Baudhuin, J. L., Diaz, G. R., Sanford, T., Harpster, R., & Valente, D. L. (2012). Use of telehealth for research and clinical measures in cochlear implant recipients: A validation study. Journal of Speech, Language, and Hearing Research, 55, 1112-1127.

    Michelle Hughes, PhD, is the Coordinator of the Cochlear Implant Program and Director of the Cochlear Implant Research Laboratory at Boys Town National Research Hospital.