Professional barriers to adult cochlear implantation: a systematic review of literature

Despite the established benefits of cochlear implantation for adults with significant hearing loss, utilisation remains low. Professional and organisational barriers may impede referral for cochlear implants (CIs). This systematic review aimed to identify and synthesise professional barriers to adult CI referral within audiological rehabilitation. A systematic search of English-language literature was performed from January 1^st 1990 to May 16^th 2025 using Medline, CINAHL, PubMed, EMBASE and PsycINFO databases. Eighteen studies met inclusion criteria, and findings were synthesised descriptively. This systematic review was registered with PROSPERO (CRD42024540394). Four themes were identified as professional barriers to adult cochlear implantation: lack of knowledge and training; concerns and beliefs about CIs and patients; organisational factors; and low prioritisation of hearing loss in healthcare. Limited clinician understanding of CI candidacy criteria and referral pathways was the most frequently reported barrier. Organisational barriers included financial disincentives related to hearing aid sales and inconsistent communication between providers. Non-audiology specialists often perceived hearing loss as a lower-priority condition, contributing to under-referral despite established criteria. Improving adult CI access requires targeted clinician education, integration of CI education with hearing aids, and reduction of financial disincentives. Future research should explore patient perspectives to identify barriers and inform intervention strategies.