ENT FEATURE

The cochlear implant clinic multidisciplinary team meeting

BY CLAIRE ISELI AND ROBERT BRIGGS

The world’s first cochlear implant clinic was in Melbourne, where multichannel devices were designed by Graeme Clark at the beginning of the cochlear implant era. We are fortunate to hear from Claire Iseli and Rob Briggs, surgeon members of this enduring clinic at the Royal Victorian Eye and Ear Hospital, to tell us how it is still done Down Under.

he cochlear implant clinic (CIC) at The Royal Victorian Eye and Ear Hospital (RVEEH) is a unique Tservice that is steeped in history. As the world’s first public hospital CIC, it commenced in 1982 following the pioneering work of Graeme Clarke and his research team. The first prototype multichannel cochlear implant was produced in 1978 and the first commercial device in 1982. Since then the service has grown in strength and size and now serves all Victorian patients considering implantable hearing devices, as well as patients from Tasmania. Through this service, over 4500 patients have received cochlear implants with subsequent programming and long-term follow-up. The CIC MDT hard at work. Over recent years the service has extended to include multiple functional sites where straightforward, with every patient having What is its purpose? recipients, as well as potential candidates, different challenges and priorities. Although The primary purpose of the meeting is attend for audiological services. The the CIC has developed standardised to bring together key members of the CIC is a hub of research, collaborating protocols for preoperative assessment, implantable device care team to determine with Melbourne University, the Hearing intraoperative surgical technique and the best advice for the individual patient on Co-operative Research Centre and the postoperative care, it is critical that these implant candidacy, expected outcomes and Bionics Institute as well as industry, to are tailored not just to the patient’s hearing post-insertion management. It ensures all improve outcomes for patients and extend relevant investigations have been done to loss, anatomy and medical conditions, but knowledge in this area. Fundamental to allow safe decision-making, and monitors also to their personal goals and individual this research has been the collection of outcomes for every patient implanted. It hearing needs. To achieve this the CIC detailed outcome data on all adult and facilitates early identification of device and multidisciplinary team meeting (MDT) has paediatric recipients. This has allowed the medical issues and ensures collaborative clinic to develop evidence-based guidelines evolved to ensure a high standard of care for care amongst the team to address these. for implant candidacy. These guidelines all patients. The MDT meeting allows standardisation continually evolve and have helped to of care across the state and develops expand cochlear implant indications What is the CIC MDT? appropriate care protocols. Essentially it worldwide. A weekly meeting of clinicians from facilitates individualised decision-making Decision-making about cochlear multiple specialty areas involved in within a standardised framework. For the implant candidacy and postoperative the care of patients with implantable patient, it ensures their care has been surgical and audiological care is not always hearing devices. considered from all perspectives and that they receive unified information about the ideal treatment plan.

“Through this service, over 4500 patients have received Secondary purposes cochlear implants with subsequent programming and Whilst the meeting is very patient-centred, it serves other purposes beyond the care long-term follow-up” of the individual. It allows monitoring and

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paediatricians, early child development history, anatomical factors and the hearing “The MDT meeting allows teams and educational institutions. These needs of the individual. A cochlear implant standardisation of care communications are then reported back to multidisciplinary meeting is a fundamental the meeting, where appropriate, for ultimate requirement for any implantable device across the state and decision-making. Minutes are distributed to service, and ensures the best available care develops appropriate care all relevant parties soon afterwards. for all the patients it serves. protocols” How we are evolving UPDATE The CIC MDT is a very effective forum for encouraging growth and development in In light of the COVID-19 pandemic, auditing of protocols and active evolution the care of cochlear implant and other we have currently suspended of these protocols as new information implantable hearing device recipients. In the face to face meeting and are is available. It also allows monitoring particular, it encourages and facilitates now running the meeting as a of outcomes on a broad and individual widening of implant candidacy through teleconference using Zoom. This is level, observing surgical, audiological and participating and reviewing the outcomes proving quite effective. device-specific aspects. Furthermore, it of local and international research relevant encourages exchange of knowledge and to our patients. In recent years this has experience between colleagues of the same included patients with more residual and different disciplines, which is team hearing as well as those with single-sided building and unifying. Through this, it helps deafness, including children. It has also “It encourages and development of relevant and contemporary allowed a wider option of implantable facilitates widening of research topics. devices available to our patient population through early incorporation of appropriately implant candidacy through How is this achieved at CIC researched new devices. The CIC continues participating and reviewing The RVEEH CIC MDT convenes weekly. to be actively involved in First in Human The core attendees are the surgeons, trials of new technology, as well as long-term the outcomes of local and audiologists and speech pathologists from research on previously implanted devices. the RVEEH CIC. In addition, representatives The MDT provides a forum for all international research from the hospital administration, social clinicians to become aware of these trials relevant to our patients” workers, researchers from Melbourne and increase recruitment, plus address any University and the Bionics institute, and questions they have about a given trial. It device manufacturer representatives are also provides an avenue for all clinicians to hear the results of recent trials to also present. This includes some enduring AUTHORS members who treated the first multichannel incorporate into their practice and for each cochlear implant recipient in Melbourne, attendee to share knowledge gained at local adding a wealth of knowledge and and international conferences. experience. More recently, the MDT meeting As the geographic range of patients has included a teleconference connection utilising this service has expanded, the to clinical units in Tasmania, Geelong and CIC has actively engaged local hearing south-east Melbourne. providers to reduce the need for patients to The meeting follows a standardised commute long distances into the centre of format: discussing new patients considering Melbourne. To maintain the high standard of care, this has been further facilitated by implantable devices in Victoria and Claire Iseli, MBBS(hons), FRACS, MS, Tasmania to determine their candidacy; teleconference attendance of these services reviewing upcoming surgical cases to at the MDT. This allows patients to feel Otologist/Neurotologist Royal Melbourne, Royal confident they are receiving standardised Victorian Eye and Ear and Royal Children’s Hospitals; ensure they are ready for surgery; and Senior Fellow University of Melbourne, Australia. reviewing the outcomes of previous care without the need for travel. cases, both immediately post-op and after device activation. Outcomes at three Future directions months and 12 months post-implant are The CIC MDT is always looking for ways also reported. It also offers a forum for to improve and evolve. Consideration discussing complicated cases encountered has been given to inclusion of non- by any of the attending clinicians. Patients implantable device representatives are generally presented for the first time such as hearing aid providers, inclusion once relevant investigations necessary to of developmental paediatricians via make a decision about implant candidacy teleconference, and greater attendance of have been completed and results are remote team members through additional Prof Robert Briggs MBBS, FRACS, FACS, available. The goal of the team is that every teleconference links. Clinical Professor, Department of Surgery, patient is presented before an implant Otolaryngology, The University of Melbourne; operation is performed. Conclusion Medical Director, Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, This team also collaborates and The care of the patient with significant Victoria, Australia. communicates with other relevant hearing loss is complex and multifaceted. specialists/services involved in patient Decision-making must incorporate not Declaration of Competing Interests: None declared. care, such as Hearing Australia, local just the degree of hearing loss but the audiologists, anaesthetists, developmental individual’s audiological and medical

ent and audiology news | MAY/JUNE 2020 | VOL 29 NO 2 | www.entandaudiologynews.com