The overall goal of this project is to validate the application of telepractice for clinical cochlear-implant (CI) services. CI services may be difficut to access for many recipients because CI centers, which represent a specialty service, are few and far between. Patients who live a considerable distance from a CI center typically incur substantial travel expenses and loss of time from work/school to attend clinic visits. Alternatively, recipients may forego necessary services because of these burdens, resulting in negative outcomes with the device. Obtaining CI services remotely via telepractice would provide an alternative for patients for whom accessibility is an issue. For telepractice to be widely implemented, all services provided in a typical visit must be validated for remote applications. Few studies have empirically evaluated remote CI service delivery;the primary focus has been on comparing programming levels obtained in the traditional versus remote conditions for adult recipients. The results of those studies have shown similar outcomes for traditional and remote measures;however, further research is needed to evaluate telepractice for other CI services and age groups. This is the goal of the current project. This research project consists of three aims.
Aim 1 will validate the use of telepractice for sound-processor programming with young children, who require the use of clinical techniques that differ from those used with adults. These include conditioned play audiometry (CPA) or visual reinforcement audiometry (VRA).
In Aim 1, behavioral thresholds for electrical stimulation obtained with either CPA or VRA will be compared for traditional versus remote programming for pediatric CI recipients. We hypothesize that there will be no significant difference between traditional and remote measures.
For Aim 2, we will develop and evaluate alternative methods for remote testing of speech perception. In our earlier work, we showed that speech perception is poorer in the remote condition because of unfavorable acoustical properties associated with the lack of a sound booth.
In Aim 2, we will evaluate whether direct audio input (DAI) to the speech processor can be used as a substitute for sound-booth testing for remote sites. Further, we will measure performance-intensity (PI) functions for various combinations of reverberation times and noise levels to explore whether PI functions can be used to correct for different background noise levels and reverberation times at remote sites, as an alternative to DAI testing.
For Aim 3, we will validate the use of telepractice for adult auditory rehabilitation (AR) Specifically, we will compare outcomes for three different interventions: (1) in-person clinician-directed AR, (2) remote clinician-directed AR, and (3) self-directed AR. We hypothesize that there will be no significant difference between traditional and remote service delivery, and that both clinician-directed groups will show greater gains than the self-directed group. By developing remote service delivery options for CI recipients, we can ultimately improve access to these specialized healthcare services.

Public Health Relevance

The primary goal of this research project is to validate the use of telepractice for clinical measures that have not previously been evaluated for cochlear implant (CI) recipients, and to solve some of the problems that currently present barriers to implementation of telepractice for this population. Results from this project will advance the use of telepractice for clinical service delivery and expand access to specialized services for CI recipients, which should lead to improved outcomes.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AUD-M (09))
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Donahue, Amy
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Father Flanagan's Boys' Home
Boys Town
United States
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