A UK clinical trial comparing cochlear implants with hearing aids in people just outside the current criteria for a cochlear implant is looking for people to take part. Could it be you?
I’m thinking back, to the last few years before I had my cochlear implant. Life was good, but it was also a time of quiet desperation as my hearing got worse. Each audiogram, the gap between the beeps I could hear getting longer, showing an inexorable slide south. Mild to moderate to severe, with the swamps of profound hearing loss beckoning at the bottom of the chart.
It probably didn’t help that I fell out of the system and didn’t have my hearing reviewed for several years, and then it was soon suggested that I might be eligible for a cochlear implant (CI), starting me off on the journey I’ve been recording through this blog. So I don’t know for how long my hearing was just a little bit better than the 80 decibel threshold that is currently a requirement for cochlear implantation in the UK.
Finding out which treatment is best
Could I have benefitted sooner from a cochlear implant? Of course, we can’t know. But we also don’t know whether CIs would help the population of people living with hearing loss that’s not quite as bad as only being able to hear sounds at 80 decibels or louder, or whether they are better off with hearing aids. This is, if you like, a ‘known unknown’.
A really good way to answer this is through a randomised controlled trial. The bare bones of it are: you take a bunch of people with a similar level of hearing loss, that grey area just above the current threshold for CIs, and a computer puts them at random into two groups. One group gets hearing aids – they can choose to keep their own or have new state-of-the-art ones and, either way, the hearing professionals involved will make sure they are set up in the best way for each person. The other group gets a cochlear implant. The research team will be collecting information about every person in the trial at set time points to see what happens and compare outcomes (in particular, understanding speech) in the two groups, up to 9 months. Everyone gets to keep their hearing device and will have all the usual appointments to make sure they get the best out of them.
This trial is happening right now, at 9 UK hospitals. It’s called the COACH Trial and the team is looking for people who are interested in taking part. This isn’t limited to people already attending, or local to, the participating hospitals and if you take part your travel expenses are paid for you.
You can find out all about it at the trial website: https://www.coachtrial.ac.uk and if you think you might be interested in joining the trial you can fill in their expression of interest form.
Will you benefit from taking part?
If your hearing is just above the current threshold, we don’t know if you’d benefit more from hearing aids or an implant which is, of course, the point of the trial. You might, and you might not.
What might be a plus for you, whichever group you’re in, is being seen regularly by hearing professionals and having their expert input. Being in the trial also means that everything happens quickly, so no long waits for appointments.
If you’re in the hearing aid group, you’ll potentially gain from having state-of-the-art new hearing aids or, if you prefer, having your existing ones set up in the best way for you. If you’re in the cochlear implant group, you’ll be getting a device that isn’t available to you on the NHS at the moment and might help you – we don’t know.
Some of the people who have already put themselves forward for the trial have found out this way that they are actually eligible for a cochlear implant on the NHS!
Will others benefit?
The expectation is that information from the trial will help improve treatment for people with hearing loss like yours in future.
Are there risks?
Both the treatments in the trial are available as standard NHS treatments, but all treatments have potential disadvantages and risks. There is more information about these on the trial website and of course these will be discussed with you.
If you think you might want to join the trial…
You’ll have a lot of things to think about and discuss. It’s important to understand that you can’t choose whether to have hearing aids or a cochlear implant – the computer decides at random. And to remember that we don’t know which is best.
I also feel quite strongly that anyone preparing to have a cochlear implant needs to know that it’s not at all like learning to hear with a hearing aid, and it’s no magic switch! It takes time and effort to get used to it. For me, there was a short period where I heard less than before, though I then went on to make enormous gains. If you want to read about my experiences before and after surgery, and over this first year or so with an implant, then you are in the right place!
But first, you might want to head over to https://www.coachtrial.ac.uk and please spread the word to anyone else you think might be interested in taking part.
There’s also a more detailed blog about the trial on Evidently Cochrane: Severe hearing loss in adults – finding out whether cochlear implants or hearing aids are better.