Remote versus in-clinic cochlear implant programming during rehabilitation: clinical outcomes and patient perspectives

Purpose Increasing cochlear implant (CI) demand due to broader candidacy and an ageing population challenges in-clinic rehabilitation. Remote programming offers a promising alternative to improve accessibility. This study evaluates its non-inferiority and optimal timing during rehabilitation.Materials and methods Forty-three postlingually deafened adults were divided into three groups: standard in-clinic fitting (n = 21), remote fitting during the second session (n = 12), and remote fitting during the third session (n = 10). Auditory outcomes at the fourth session were assessed using speech perception phoneme score at 65 dB SPL (primary outcome measure), free-field tone audiometry and programming parameters (M- and T-levels). Patient experiences with remote programming were evaluated via a dedicated questionnaire. Non-inferiority of remote versus in-clinic fitting was assessed.Results Speech perception phoneme score at 65 dB SPL was 73% (SD = 11) in the remote group and 76% (SD = 11) in the in-clinic group, with a mean difference of −3% (95% CI: −9.4 to 3.9), meeting the pre-specified non-inferiority margin. Free-field tone audiometry thresholds were not significantly different (remote: 24 ± 5 dB HL; in-clinic: 25 ± 5 dB HL). Patients without remote experience expressed more negative perceptions about the concept, whereas those with firsthand experience reported high satisfaction, ease of use, and willingness to continue remote sessions.Conclusions Replacing one rehabilitation appointment with a remote fitting is non-inferior to standard in-clinic fitting for speech perception outcomes. Most patients reported high satisfaction, supporting its feasibility and accessibility.