Cochlear Implant Cost

A Modern Cochlear Implant Can Justify its Cost

For an adult whose hearing loss has attained a level regarded as severe to profound, and who has been unable to gain any demonstrable benefit from the amplified sounds produced by a conventional hearing aid, the future would once have been rather bleak. Just a few decades ago, he or she would have been condemned to a world of silence, unable to communicate (except by means of sign language), and possibly be forced to retire prematurely and be excluded from any opportunity to obtain alternative employment.

For a child affected in this fashion from birth, the consequence would previously have been never to hear the voices of his or her mother and father or siblings. He or she would have been isolated from children with normal hearing when required to attend special schools, and would have looked forward to a life devoid of music and normal conversation, with limited future prospects. If such individuals had access to the multichannel cochlear implant technology first introduced in 1984, it seems likely that, given the alternatives, the cost involved in accessing this revolutionary option would only have been a secondary concern.

In the case of those patients who are considered suitable for an implanted device, the result can be life-changing, but it needs to be understood that it does not produce quite the same sensation of sound as that experienced by those with normal, unassisted hearing. The explanation is to be found in the manner in which these devices must function, in order to overcome the subject’s auditory impairment. Typically, the candidates for implantation are severely affected by a condition originating in the inner ear and known as sensorineural deafness. So, what is responsible for this condition?

From the time that sound waves first enter the outer ear, the bulk of their continued travel is the result of conduction, first in a solid and later in a liquid. First, the eardrum or tympanic membrane is vibrated, and this agitates a series of three tiny, connected bones located within the middle ear. The last of these transfers the mechanical vibrations to the “window” of a structure in the inner ear, known as the cochlea, the organ to which the term cochlear implant refers. Fluid within this structure is then vibrated, causing the delicate hairs protruding from the specialised cells lining its walls to move and generate nerve impulses that are relayed to the auditory centres in the brain by the auditory nerve. If these cells become damaged, no nervous impulses are generated, and the cost to those affected is sensorineural hearing loss. The greater the number of hair cells damaged, the more severe the resulting impairment.

The implanted device woks by bypassing the entire conductive structure and relaying the digitised output from a microphone and speech processor via an electrical charge through an array of electrodes inserted into the cochlea. Although it is not a genuine nerve impulse, the electrical signal is also transmitted to the brain via the auditory nerve, providing that it is intact and functional. These signals produce a sensation in the auditory centres that the patient soon learns to identify with the specific sounds of speech and music. Following some adjustment of the device, and perhaps the assistance of a speech therapist in some cases, patients should soon be able to communicate effectively, and enjoy audible, as well as visual entertainment – in some cases, for the first time in their lives. How does one place a price on that?

Naturally, there is a price to be paid, and in addition to these devices being more expensive than a conventional hearing aid, when pricing a cochlear implant, the additional costs arising from the initial evaluation, the surgery itself and any post-operative follow-ups that may prove necessary, will also need to be taken into account. While the total outlay can be quite substantial, the bulk of this will normally be covered by most of the medical aid schemes in South Africa, and the annual allocations should also be sufficient for any ongoing maintenance required in future years. To ensure that patients are spared from any unnecessary expense, an in-depth, preliminary evaluation process is jointly conducted by an audiologist and an ENT surgeon, and is designed to identify only those candidates for whom a positive outcome is most likely.

Ear Institute clinics offer cutting-edge audiology services, world-class products and expert consultation regarding assisted hearing options.
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