Aug 2020 The Hearing Journal

Since the approval of the first single-channel cochlear implant (CI) in 1984, these devices rapidly advanced with the introduction of more robust multi-channel CIs, which were approved by the U.S. Food and Drug Administration (FDA) for adults in 1987 and children in 1990. From the start, CI development was an extraordinary collaborative effort with researchers, clinicians, and companies that worked together to refine and offer the evolving technology and follow-up care via diverse CI teams composed of ENT surgeons, audiologists, speech-language pathologists, educators, psychologists, social workers, and others. Cochlear implantation is one of the 20th century's most consequential developments in communication and in offering the restoration of sound to those who are deaf, but despite the rapid trajectory in the expansion of CI benefits, overall utilisation rates have remained relatively low. Paediatric utilisation in the United States is approximately 55 to 60 percent, which is well below that in many European countries and the U.S. adult utilisation rates hover at 10 percent or less. These low numbers can be due to a host of reasons, such as an unrealistic understanding of CI cost, fear of surgery and losing residual hearing, uncertainties of whether the outcome will be successful, oppositions within the Deaf community, and continued attempts at traditional amplification use.

To address the lack of progress in expanding CI access, the American Cochlear Implant Alliance (ACI Alliance; was organised in late 2011 by a collaboration of CI clinicians. While numerous organisations representing professionals, patients, and parents exist, none of them specifically focus on CI—and thus the work of ACI Alliance began. The organisation was envisioned to be a unique alliance, bringing together the interests of various members and collaborating with other groups on hearing health care and disability. As our advocacy activities evolved, the interest and participation of patients and parents also expanded.

From the outset, the mission of the ACI Alliance has been to improve CI access through research, advocacy, and awareness. To do so, the alliance organises an annual research conference, which serves as a venue to share updates in the field, including advances in technology and clinical care. The annual CI meeting is also an opportunity for those most intensively involved in advocacy, the organisation's 117 State Champions, to meet and plan activities at the state and national levels. The CI2020 International Conference, which focused on expanding CI indications in children and adults, was scheduled on March 18-21 in Orlando, FL, with 1,500 registered attendees from across the globe. The program was thoughtfully developed by our Scientific Research Committee from the University of North Carolina (UNC) chaired by Kevin Brown, MD, Margaret Dillon, AuD, and Harold Pillsbury, MD, FACS, and included cutting-edge topics like CIs for single-sided deafness, bimodal/bilateral CIs, and cognitive impacts.

As COVID-19 spread within the United States and around the world in the early months of 2020, it became evident that the conference could not be held as planned. Many of our members are from academic medical institutions, and institutional travel bans due to the pandemic prevented them from leaving their respective U.S. states. Data offered by epidemiologists at leading institutions also made it clear that a gathering of more than 10 people would be irresponsible and dangerous. Like thousands of other conferences around the world, we canceled our in-person event and fully refunded registrations.

As expected, our members, exhibitors, and supporters were devastated by the cancellation of what would have been the largest, most prominent international gathering on CI clinical research in 2020. While a tremendous amount of work always goes into planning the annual meeting, this year was special since it was the year for the international conference, which is only held in the United States every four years.

With the help of several tech-savvy partners, we quickly decided to move as much conference content as possible to an online format and to make attendance free for all members and non-members of the ACI Alliance. The next step was to ask our UNC Scientific Research Committee if they would be willing to coordinate the online program based on the content and the presenters who had planned to be with us in Orlando. Without hesitation, the UNC co-chairs were up to the challenge! Our sponsors generously allowed us to retain their educational grants to support the work of the organisation. AudiologyOnline (AO) quickly stepped up and worked with 45 presenters from around the world to record the 13 hours of content—all offered with CEUs—on the AO platform. By May 4, the entire conference was available for viewing. Who would have thought it was possible?

The focus of the online conference was to assemble three distinct sessions with novel contents: session one on individualised mapping, challenging mapping cases, expanding indications; session two on CI in young children, supporting patients and families, practice management, and access to care; and session three on asymmetric hearing loss, challenging surgical cases, cognition, bimodal/bilateral, electric-acoustic stimulation. Each session had four to five hours of presentations by respected CI clinicians and an additional hour organised by a CI manufacturer. The conference contents are available on-demand and eligible for CEUs for members of AO or

The presentations are of interest to all CI professionals and most hearing health professionals outside of CI, particularly the content on expanding indications; CI in young children; CI for asymmetric hearing loss, including single-sided deafness, bimodal hearing (CI on one side, hearing aid on the other), and electric-acoustic stimulation (CI for high-frequency hearing/hearing aid for low-frequency hearing in the same ear). This is in line with our goal to develop a program that would also appeal to other hearing health care providers (outside of cochlear implantation) who typically do not participate in the in-person CI meeting given the time and travel involved.

As of June 16, we have received over 3,100 registrations for the CI2020 Online program. Reviews have been stellar, with attendees expressing appreciation for making the content available so quickly. We were humbled by the comments, and would like to share a few of them:

Cutting-edge research, clear examples. Loved learning from experts from all over the nation and world! I was so bummed when CI2020 was canceled and so grateful for the hard work all presenters put in to make this available online so quickly!The wide array of presenters and a variety of topics are all relevant to our practice.

We were able to quickly organise and host this extraordinary online conference because of the collaborative spirit and enthusiasm in our field, which are reflective of our concerted approach to cochlear implantation and our dedication to keep the field moving forward for the benefit of our patients. ACI Alliance is beyond grateful to our members, sponsors, and friends for their unwavering commitment to the organisation's mission and success.

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