targetedevidencereport.docVIP

Targeted Evidence Report Cochlear Implants and Commercial?Motor Vehicle Driver Safety Presented to The Federal Motor Carrier Safety Administration October 29, 2010 Revised January 14, 2011 MANILA Consulting Group, Inc. 1420 Beverly Road, Suite 220 McLean, VA 22101 Authorship Michelle Bieber-Tregear, PhD MANILA Consulting Group Dana Connor, BA MANILA Consulting Group Stephen Tregear, DPhil MANILA Consulting Group Policy Statement This report was prepared by MANILA Consulting Group, Inc. under Contract No. GS-10F-0177N; Order No. DTMC75-10-F-00013, entitled “Medical Programs Research and Analysis Panels Project, with the Department of Transportation’s Federal Motor Carrier Safety Administration.  Table of Contents Executive Summary 5 Preface 8 1. Introduction 10 2. Background on Hearing and Cochlear Implants 12 2.1. Normal Hearing 12 2.2. Hearing Loss 14 2.2.1. Sensorineural Hearing Loss 15 2.2.2. Treatment of Sensorineural Hearing Loss 15 2.3. Cochlear Implants 15 2.4. Types of Cochlear Implants 17 2.4.1. Indications for Cochlear Implants 18 2.4.2. Current Guidelines for the use of Cochlear Implants 19 2.5. Current Trends in Cochlear Implantation 20 2.6. Incidence and Indications for Cochlear Implantation Failure and Revision 21 3. Comparison of Relevant Regulations 23 3.1. Regulatory Medical Fitness Standards and Guidelines in Other Countries 23 3.2. Medical Fitness Standards and Guidelines for Individuals Performing Additional Transportation-Related Occupations in the United States 36 4. Evidence Summary 41 4.1. Key Research Question 1: How effective are cochlear implants, and is auditory function following cochlear implantation restored to a level that would permit safe driving as established by existing Federal standards for hearing? 41 4.1.1. Summary of Relevant Literature 42 4.1.2. Summary of Evidence for the Effectiveness of Cochlear Implants 49 4.2. Key Research Question 2: What is the nature of hearing capability fol