Lessons learned from the COVID-19 pandemic for future cochlear implant service preparedness: a multicenter study

BACKGROUND: Cochlear implantation (CI) is a highly effective intervention for severe-to-profound hearing loss; however, the COVID-19 pandemic disrupted established CI service delivery worldwide. Maintaining access to this resource-intensive procedure during public health emergencies is critical, particularly for pediatric patients in whom delays may compromise auditory and language development. METHODS: This multicenter retrospective comparative study analyzed CI service delivery across seven centers in Bahrain and Saudi Arabia, comparing pre-pandemic and pandemic periods over six months. Data included procedural volumes, waiting lists, committee activity, surgical workflows, intraoperative testing, and adoption of telehealth for fitting and rehabilitation.Generalized estimating equations were used to account for center-level clustering. RESULTS: A total of 984 CI procedures were analyzed. Overall implant volume was preserved during the pandemic, while waiting lists increased by 31%. Telehealth adoption expanded markedly, with all remote fitting sessions and nearly all remote rehabilitation sessions occurring during the COVID-19 pandemic. Unilateral operating time decreased significantly, reflecting streamlined surgical workflows. Committee activity and intraoperative testing practices demonstrated center-specific adaptations. CONCLUSION: CI services demonstrated resilience during the COVID-19 pandemic through rapid telehealth integration and surgical workflow optimization. However, increased waiting lists highlight critical vulnerability, particularly for pediatric candidates. Hybrid care models and contingency planning should be formally integrated into future CI service frameworks.