A consensus committee is to identify and recommend generalized testing procedures and criteria for evaluating the level of functional hearing ability needed to make a disability determination in adults and children after cochlear implantation. The committee will produce a report detailing and supporting their findings, conclusions, and recommendations based on published evidence (to the extent possible) and professional judgement (where published evidence is lacking). The committee will:

1. Identify and describe the salient test characteristics of the HINT, which is currently used to determine the functional hearing ability in adults or children with hearing loss treated with cochlear implantation, and provide recommendations as to how to generalize those characteristics into criteria that can be applied to other validated hearing tests for persons with cochlear implants.

2. Describe the characteristics of hearing tests, administered in the sound field, either binaurally or monaurally, in either quiet or noise, that are in use for those with cochlear implants, and describe to the degree possible:

a. The availability of the selected tests with respect to the instruments themselves, trained administrators of the tests, and insurance coverage or costs incurred with testing;

b. The patient burden of undergoing these tests;

c. Whether testing procedures or parameters, or the appropriateness of the test itself, vary based on the age of the person being tested;

d. Whether the test outcomes are expected to vary based on demographic or other patient characteristic factors, including repeated testing with the same instrument; and

e. The validity, specificity, sensitivity, reliability, and generalizability of the tests.

3. Among the hearing tests described in task 2, identify those with characteristics most similar to the HINT, determine which tests, performed in the sound field, either binaurally or monaurally, in either quiet or noise, produce measurements most closely analogous to the word recognition score of the HINT (given HINT testing parameters of properly functioning cochlear implants set at normal settings, with no visual testing cues, in a quiet sound field, at 60 dB HL), and describe to the degree possible:

a. What differences exist between the identified tests and the HINT in terms of the specific elements of hearing ability they measure;

b. The committee’s recommendations as to how scores from the identified tests can be compared or converted to equivalent scores on the HINT; and

c. The committee’s recommendations for the scores on hearing tests that correspond to a level of functional hearing ability that causes marked and severe functional limitation; whether those scores or outcome measures can be expressed in a form comparable between hearing tests such as percentile or standard deviation from the norm.

4. Examine the special considerations inherent in evaluating hearing ability in persons with single-sided deafness or asymmetric hearing loss receiving a cochlear implant and describe:

a. Any special considerations in the testing and treatment of persons with bilateral but unequal hearing loss;

b. Whether there is a correlation between the presence and degree of hearing loss in the less-affected ear and the recovery time or treatment for individuals with single-sided deafness or asymmetric hearing loss receiving a cochlear implant in their more-affected ear;

c. Whether there is a level of hearing ability in the less-affected ear which would render cochlear implantation in the more-affected ear immaterial with respect to meeting the severity of hearing loss in the listings (i.e., would not prevent an adult from engaging in any gainful activity nor a child from having "marked" limitations in two domains of functioning or an "extreme" limitation in one domain[1]);

d. Whether the tests identified in task 3 remain appropriate for testing hearing ability in persons with single-sided deafness or asymmetric hearing loss receiving a cochlear implant and why, and if there are any differences in how the tests should be administered or interpreted; and

e. Whether the equivalent scores identified in task 3 remain accurate proxies for the HINT word recognition scores when assessing persons with single-sided deafness or asymmetric hearing loss receiving a cochlear implant.

[1] See 20 Code of Federal Regulations (CFR) 416.926a and DI 25225.030, DI 25225.035, DI 25225.040, DI 25225.045, DI 25225.050, and DI 25225.055.