Copyright © 2017 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. Duration of Eligibility Prior to Cochlear Implantation: Have We Made Any Progress?  Eric N. Appelbaum,  Shannon S. Yoo, yRobert A. Perera, and  Daniel H. Coelho  Department of Otolaryngology—Head and Neck Surgery; and yDepartment of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia Objective: The objective is to determine if eligibility (as defined as the duration of severe to profound hearing loss before cochlear implantation [CI]) has changed over the 30 years since Food and Drug Administration approval. Data Sources: English-language, peer-reviewed articles, the- ses, and trial data available through PubMed and Cochrane Library databases up until and including May 31, 2016. Study Selection: One thousand six unique articles were identi- fied. Prospective studies that reported duration of severe/ profound hearing loss before CI in adult patients were included. Retrospective studies, reviews, meta-analyses, articles reporting pediatric or mixed data, hybrid/electroacoustic CI, and articles from centers outside the United States were excluded. Seventy- one studies met inclusion criteria and were included for analysis. Data Extraction: Contributing authors independently reviewed included studies for data validity and applicability. Data Synthesis: Metaregression was used to assess the relationship between the year of publication and duration of hearing loss. To account for a possible age effect, a second model was estimated including mean age at the time of study as a covariate. Conclusion: A positive association between study year and the duration of hearing loss before implantation was found showing a 0.28-year increase in the duration of hearing loss for every increasing study year. Contrary to conventional assumption, duration of eligibility for CI appears to be increasing. Though the reasons for this are not clear, current strategies to increase both awareness and access to CI seem to be falling short. Key Words: Cochlear implant—Cochlear implant candidacy—Cochlear implantation—Hearing loss. Otol Neurotol 38:xxx–xxx, 2017. Since its approval by the Food and Drug Administration (FDA) in 1985, cochlear implantation (CI) has become an enormously important tool for treating adults with senso- rineural hearing loss (1). In the adult patient population, cochlear implants have traditionally been considered for those with severe to profound hearing loss, though more recently those with moderate sensorineural loss and those who struggle with hearing despite the use of hearing aids have also been considered appropriate candidates (2). Their use has been shown to greatly improve the quality of life while remaining cost effective (3,4). While outcomes are generally excellent, numerous variables influence performance. These include intrinsic patient factors (e.g., age, prelingual versus postlingual loss, neuronal count, duration of hearing loss, cochlear malformations, developmental delay, etc.) and extrinsic technology and programming factors (e.g., processing strategy, electrode design, surgical technique, frequency and quality of programming, etc.) Of these, duration of severe hearing loss is one of the most important predic- tors of postoperative performance, with a shorter duration of severe hearing loss resulting in a better outcome (2,5 – 7). To quantify the impact, Friedland et al. (8) estimate that every year of additional severe to profound hearing loss resulted in a 1% decline postoperative word scores. Conventional wisdom suggests that awareness and re- ferral patterns for appropriate candidates are, although suboptimal, improving. Theoretically, it follows that du- ration of severe to profound sensorineural hearing loss could serve as a reasonable proxy to estimate trends in access to and utilization of cochlear implants. The objec- tive of this study is to use prospective studies characterize how duration of severe to profound hearing loss before CI has changed over the 30 years since FDA approval. We hypothesize that as general awareness and provider famil- iarity has improved, the time from diagnosis of severe to profound sensorineural hearing loss to CI decreases. METHODS Data Sources English-language, peer-reviewed articles, theses, and clini- cal trial data available through PubMed and Cochrane Library Address correspondence and reprint requests to Daniel H. Coelho, M.D., Department of Otolaryngology—Head and Neck Surgery, Vir- ginia Commonwealth University Medical Center, PO Box 980146, Richmond, VA 23298-0146; E-mail: daniel.coelho@vcuhealth.org D.H.C. serves as a member of the Surgeons Advisory Board for Med El. The authors disclose no conflicts of interest. Supplemental digital content is available in the text. DOI: 10.1097/MAO.0000000000001544 1 Otology & Neurotology xx:xx–xx ß 2017, Otology & Neurotology, Inc.