Remote versus in-clinic cochlear implant programming during rehabilitation: clinical outcomes and patient perspectives

Increasing cochlear implant (CI) demand due to broader candidacy and an ageing population challenges in-clinic rehabilitation. Remote programming offers a promising alternative to improve accessibility. This study evaluates its non-inferiority and optimal timing during rehabilitation. Forty-three postlingually deafened adults were divided into three groups: standard in-clinic fitting (n = 21), remote fitting during the second session (n = 12), and remote fitting during the third session (n = 10). Auditory outcomes at the fourth session were assessed using speech perception phoneme score at 65 dB SPL (primary outcome measure), free-field tone audiometry and programming parameters (M- and T-levels). Patient experiences with remote programming were evaluated via a dedicated questionnaire. Non-inferiority of remote versus in-clinic fitting was assessed. Speech perception phoneme score at 65 dB SPL was 73% (SD = 11) in the remote group and 76% (SD = 11) in the in-clinic group, with a mean difference of −3% (95% CI: −9.4 to 3.9), meeting the pre-specified non-inferiority margin. Free-field tone audiometry thresholds were not significantly different (remote: 24 ± 5 dB HL; in-clinic: 25 ± 5 dB HL). Patients without remote experience expressed more negative perceptions about the concept, whereas those with firsthand experience reported high satisfaction, ease of use, and willingness to continue remote sessions. Replacing one rehabilitation appointment with a remote fitting is non-inferior to standard in-clinic fitting for speech perception outcomes. Most patients reported high satisfaction, supporting its feasibility and accessibility. Remote fitting sessions can reduce travel burden and improve accessibility for patients with mobility or logistical challenges.One in-clinic rehabilitation appointment can be replaced with a remote cochlear implant fitting without compromising speech perception outcomes.Combining in-clinic and remote sessions in a hybrid rehabilitation model may increase efficiency and allow more patient-centered care. Remote fitting sessions can reduce travel burden and improve accessibility for patients with mobility or logistical challenges. One in-clinic rehabilitation appointment can be replaced with a remote cochlear implant fitting without compromising speech perception outcomes. Combining in-clinic and remote sessions in a hybrid rehabilitation model may increase efficiency and allow more patient-centered care.

随着人工耳蜗（cochlear implant, CI）适配指征拓宽与人口老龄化加剧，门诊康复服务面临愈发严峻的需求挑战。远程调试作为极具前景的替代方案，可有效提升康复服务的可及性。本研究旨在评估人工耳蜗远程调试的非劣效性，并探索其在康复流程中的最佳实施时机。本研究共纳入43名语后聋成年患者，将其分为三组：标准门诊调试组（n=21）、第二次随访时实施远程调试组（n=12）以及第三次随访时实施远程调试组（n=10）。于第四次随访时评估听觉结局：主要结局指标为65dB声压级（sound pressure level, SPL）下的言语识别音素得分，次要评估指标包括自由场纯音测听结果以及调试参数（M级与T级）。通过专用问卷调查表，评估患者对远程调试的使用体验。本研究同时评估了远程调试相较于门诊调试的非劣效性。65dB SPL下的言语识别音素得分显示，远程调试组为73%（标准差standard deviation, SD=11），门诊调试组为76%（SD=11），组间平均差异为-3%（95%置信区间confidence interval, CI：-9.4~3.9），符合预先设定的非劣效界值要求。自由场纯音测听阈值组间无显著差异（远程调试组：24±5dB听力级hearing level, HL；门诊调试组：25±5dB HL）。无远程调试使用经历的患者对该方案持更负面的态度，而有亲身使用体验的患者则表示高度满意、认为操作便捷且愿意继续接受远程随访。以远程调试替代一次康复门诊随访，在言语识别结局方面与标准门诊调试方案非劣效。大多数患者表示高度满意，证实了该方案的可行性与可及性。远程调试随访可减轻行动不便或存在后勤保障困难患者的出行负担，提升康复服务可及性。一次康复门诊随访可替换为人工耳蜗远程调试，且不会对言语识别结局造成负面影响。采用门诊与远程结合的混合康复模式，可提升康复效率，实现更以患者为中心的诊疗服务。远程调试随访可减轻行动不便或存在后勤保障困难患者的出行负担，提升康复服务可及性。一次康复门诊随访可替换为人工耳蜗远程调试，且不会对言语识别结局造成负面影响。采用门诊与远程结合的混合康复模式，可提升康复效率，实现更以患者为中心的诊疗服务。