{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T02:31:31Z","timestamp":1773369091792,"version":"3.50.1"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec id=\"ab-ooi250089-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Despite the proven benefits of a cochlear implant, utilization rates remain low. Current screening tools have improved awareness but rely on binary classification (candidate vs noncandidate), limiting individualized counseling and shared decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250089-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a risk stratification system for cochlear implant candidacy based on routine audiometric data, enabling individualized estimates of cochlear implant candidacy likelihood, supporting improved shared decision-making<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250089-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective cohort study including adults with hearing loss was conducted at a single tertiary academic center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250089-7\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consonant-nucleus-consonant (CNC) scores of 50% or lower were used as candidacy criteria. A conjunctive consolidation approach was used to classify patients into 4 audiometric severity stages, combining pure tone average (PTA) and word recognition score (WRS) cutoffs. Groups were informed by clinical judgment and statistical isometry. Discriminative power was assessed using the C statistic. A secondary stratification system was developed using AzBio sentences (\u226460% in quiet or +10 dB on signal-to-noise ratio examination) to define candidacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250089-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1312 patients with complete data and PTA below 100 dB, 782 (59.6%) met cochlear implant candidacy criteria based on CNC scores of 50% or lower. The 4-stage classification system showed a clear gradient of candidacy likelihood, ranging from 2.8% in stage 0 to 88.5% in stage 3, with strong discriminative power (C\u2009=\u20090.83; 95% CI, 0.81-0.85). Similar trends were observed when candidacy was defined by AzBio scores, with strong model discrimination (C\u2009=\u20090.80; 95% CI, 0.77-0.83). Demographic factors such as age and duration of hearing loss did not enhance model performance and were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250089-9\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This cohort study found that patients with hearing loss can be effectively stratified by likelihood of cochlear implant candidacy using routine audiometric data. This 4-level classification system offers a simple, clinically intuitive method to estimate candidacy probability, moving beyond binary screening and supporting personalized, data-driven decision-making between clinicians and patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2025.4882","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T16:01:31Z","timestamp":1768492891000},"page":"276","source":"Crossref","is-referenced-by-count":0,"title":["Cochlear Implant Candidacy Support Tool Using Conjunctive Consolidation"],"prefix":"10.1001","volume":"152","author":[{"given":"Kevin","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Bray","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorina","family":"Kallogjeri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Statistics Editor, JAMA Otolaryngology\u2013Head and Neck Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay F.","family":"Piccirillo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Editor in Chief, JAMA Otolaryngology\u2013Head and Neck Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cole","family":"Pavelchek","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Oregon Health and Science University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Jawad","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Ortmann","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon","family":"Lefler","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nedim","family":"Durakovic","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawina","family":"Jiramongkolchai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacques A.","family":"Herzog","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig A.","family":"Buchman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew A.","family":"Shew","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Associate Editor for AI and Digital Health, JAMA Otolaryngology\u2013Head and Neck Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"10452","key":"ooi250089r2","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission.","volume":"404","author":"Livingston","year":"2024","journal-title":"Lancet"},{"issue":"7","key":"ooi250089r3","doi-asserted-by":"publisher","DOI":"10.1121\/10.0012825","article-title":"Celebrating the one millionth cochlear implant.","volume":"2","author":"Zeng","year":"2022","journal-title":"JASA Express Lett"},{"issue":"5","key":"ooi250089r4","doi-asserted-by":"publisher","first-page":"e558","DOI":"10.1097\/MAO.0000000000003513","article-title":"Current estimates of cochlear implant utilization in the United States.","volume":"43","author":"Nassiri","year":"2022","journal-title":"Otol Neurotol"},{"issue":"2","key":"ooi250089r5","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1097\/AUD.0000000000000762","article-title":"Barriers and facilitators to cochlear implant uptake in Australia and the United Kingdom.","volume":"41","author":"Bierbaum","year":"2020","journal-title":"Ear Hear"},{"issue":"11","key":"ooi250089r6","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1080\/14992027.2023.2298751","article-title":"Cochlear implant referral patterns in the UK suggest a postcode lottery with inequitable access for older adults; results of a pilot audit in five Audiology sites.","volume":"63","author":"Cullington","year":"2024","journal-title":"Int J Audiol"},{"issue":"4","key":"ooi250089r7","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1055\/s-0041-1739281","article-title":"Barriers to adult cochlear implant care in the United States: an analysis of health care delivery.","volume":"42","author":"Nassiri","year":"2021","journal-title":"Semin Hear"},{"issue":"6","key":"ooi250089r8","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1177\/01945998211027340","article-title":"Racial disparities in adult cochlear implantation.","volume":"166","author":"Mahendran","year":"2022","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"9","key":"ooi250089r9","doi-asserted-by":"publisher","first-page":"e1000","DOI":"10.1097\/MAO.0000000000003678","article-title":"External validation of cochlear implant screening tools demonstrates modest generalizability.","volume":"43","author":"Lee","year":"2022","journal-title":"Otol Neurotol"},{"issue":"7","key":"ooi250089r10","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1097\/MAO.0000000000002664","article-title":"Development of a 60\/60 guideline for referring adults for a traditional cochlear implant candidacy evaluation.","volume":"41","author":"Zwolan","year":"2020","journal-title":"Otol Neurotol"},{"issue":"4","key":"ooi250089r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2024.104337","article-title":"AI model for predicting adult cochlear implant candidacy using routine behavioral audiometry.","volume":"45","author":"Carlson","year":"2024","journal-title":"Am J Otolaryngol"},{"issue":"7","key":"ooi250089r12","doi-asserted-by":"publisher","first-page":"e486","DOI":"10.1097\/MAO.0000000000003927","article-title":"Machine learning approach for screening cochlear implant candidates: comparing with the 60\/60 guideline.","volume":"44","author":"Patro","year":"2023","journal-title":"Otol Neurotol"},{"issue":"3","key":"ooi250089r13","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1002\/lio2.804","article-title":"Candidacy for Cochlear implantation: validating a novel Cochlear implant candidacy calculator against gold-standard, in-clinic audiometric assessments.","volume":"7","author":"So","year":"2022","journal-title":"Laryngoscope Investig Otolaryngol"},{"issue":"12","key":"ooi250089r14","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1001\/jamaoto.2019.1035","article-title":"Association of preoperative functional performance with outcomes after surgical treatment of head and neck cancer: a clinical severity staging system.","volume":"145","author":"Sindhar","year":"2019","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"11","key":"ooi250089r15","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1001\/jamaoto.2021.2626","article-title":"Clinical staging to estimate the probability of severe postoperative complications in patients with vestibular schwannoma.","volume":"147","author":"Smith","year":"2021","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"1","key":"ooi250089r16","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1002\/ohn.486","article-title":"Identifying predictors of treatment response in Meniere\u2019s disease: a clinical severity staging system.","volume":"170","author":"Miller","year":"2024","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1","key":"ooi250089r17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00005792-199001000-00001","article-title":"A clinical-severity staging system for patients with lung cancer.","volume":"69","author":"Feinstein","year":"1990","journal-title":"Medicine (Baltimore)"},{"issue":"12","key":"ooi250089r18","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1001\/jamaoto.2017.0550","article-title":"Development of a new clinical severity staging system for patients with nonmetastatic papillary thyroid carcinoma.","volume":"143","author":"Karadaghy","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"ooi250089r19","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1044\/jshd.2701.62","article-title":"Revised CNC lists for auditory tests.","volume":"27","author":"Peterson","year":"1962","journal-title":"J Speech Hear Disord"},{"issue":"1","key":"ooi250089r20","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/AUD.0b013e31822c2549","article-title":"Development and validation of the AzBio sentence lists.","volume":"33","author":"Spahr","year":"2012","journal-title":"Ear Hear"},{"issue":"2","key":"ooi250089r21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0281337","article-title":"Imputation of missing values for cochlear implant candidate audiometric data and potential applications.","volume":"18","author":"Pavelchek","year":"2023","journal-title":"PLoS One"},{"issue":"suppl 3","key":"ooi250089r22","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lary.30879","article-title":"American Cochlear Implant Alliance Task Force: recommendations for determining cochlear implant candidacy in adults.","volume":"134","author":"Zeitler","year":"2024","journal-title":"Laryngoscope"},{"issue":"43","key":"ooi250089r23","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the Tidyverse.","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Softw"},{"issue":"6","key":"ooi250089r27","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1002\/lio2.673","article-title":"Development of a novel screening tool for predicting Cochlear implant candidacy.","volume":"6","author":"Ngombu","year":"2021","journal-title":"Laryngoscope Investig Otolaryngol"},{"issue":"3","key":"ooi250089r28","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1044\/2024_AJA-24-00008","article-title":"A consensus to revise the minimum speech test battery-version 3.","volume":"33","author":"Dunn","year":"2024","journal-title":"Am J Audiol"},{"issue":"3","key":"ooi250089r29","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1177\/0194599812471500","article-title":"Practical guide to understanding multivariable analyses, Part B: conjunctive consolidation.","volume":"148","author":"Neely","year":"2013","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"7","key":"ooi250089r30","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1001\/jamaoto.2020.0662","article-title":"Association of patient-related factors with adult cochlear implant speech recognition outcomes: a meta-analysis.","volume":"146","author":"Zhao","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"2","key":"ooi250089r31","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1044\/jshd.4602.213","article-title":"The effect of word list and talker variation on word recognition scores using time-altered speech.","volume":"46","author":"De Chicchis","year":"1981","journal-title":"J Speech Hear Disord"},{"issue":"3","key":"ooi250089r32","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1044\/jshr.2103.507","article-title":"Speech-discrimination scores modeled as a binomial variable.","volume":"21","author":"Thornton","year":"1978","journal-title":"J Speech Hear Res"},{"issue":"7","key":"ooi250089r33","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1097\/MAO.0000000000004429","article-title":"Qualifying cochlear implant candidates-does it matter how patients are qualified?","volume":"46","author":"Lee","year":"2025","journal-title":"Otol Neurotol"},{"key":"ooi250089r26","volume-title":"An R Companion to Applied Regression","author":"Fox","year":"2019","edition":"3rd ed"},{"key":"ooi250089r1","unstructured":"Organization? WH. Deafness and hearing loss. World Health Organizatiion. Accessed September 11, 2024. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/deafness-and-hearing-loss"},{"key":"ooi250089r24","unstructured":"Xie? Y. knitr: A general-purpose package for dynamic report generation in R. R package version 1.50. 2025. Accessed September 11, 2024. https:\/\/yihui.org\/knitr\/"},{"key":"ooi250089r25","unstructured":"Robinson? D, Hayes? A, Couch? S, Hvitfeldt? E. broom: Convert Statistical Objects into Tidy Tibbles. R package version 1.0.11. 2025. Accessed September 11, 2024. https:\/\/broom.tidymodels.org\/"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2843795\/jamaotolaryngology_chen_2026_oi_250089_1771965319.02069.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:00:22Z","timestamp":1773327622000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2843795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2025.4882","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}