Page 61 - Spring 2019
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vative esti.rnate, approximately 1% of the people who could worse loss in hearing one side but normal or nearly normal
benefit from a CI has received one. hearing on the other side, can be candidates for receiving a CI.
1 think a population health perspective would be helpful in These efforts and differences did not move the needle in the
increasing the access; progress already has been made along clockwise direction. New approaches are obviously needed,
these lines (Zeng, 2017). Access is li.rnited by the cost of the and some of the possibilities are presented by Wilson (2015,
device but also by the awilability of trained medical person- 2018), Zeng (2017), and Wilson and Dorman (2018b); one
nel; the infrastructure for healthcare in a region or country; of those possibilities is to pay more attention to the “hearing
awareness of the benefits of the CI at the policy levels such as brain” in designs and applications of Cls.
the Ministries of Finance and Ministries of Health; the cost of _ _ _ _
surgery and fo]low_“P Care; addmoml Costs assodmed Wm] Better performance with unilateral (‘Cls is u'nportant because
the care for patients in remote regions far from tertiary-care l-lol all pllllel-‘ls or Plospelfllve allel-‘ls llalfe access to’ or
hospitals; banery expenses; ‘he Cost for manufacmrers in could benefit from, the adiunctive stu-nulation treatments.
meeting regulamry requiremems; the Cost for manufadurers -In particular, not all patients have_enough residual hearing
in supporting clinics; the cost of marketing where needed; ll-l ellllel ear lo_ llel-lelll from fomlllned EAS <_D°lmal-l_el a_l"
and the cost of at least minimal profits to sustain manufac- 20l5)’ even Wll_ll the lelaxallolls ll-l llle Cal-llllllacy Clllella’
turing enterprises. Access might be increased by viewing it alllfl llol all P_allelllS have access to llll_alelal Cls due l_° le-
as a mumfacemd problem tha‘ includes an of ‘hese fade“ strictions in insurance coverage or national health policies.
and not just the cost of the device, although that is certainly Fullllellllole’ llle Pe_ll°ll-llallce of llle “nllalelal Cl ls llle
importam (Emmen 6‘ E1” 2015)_ foundation of the adiunctive treatments and an increase in
performance for unilateral Cls would be expected to boost
Eflbns are ““de1'w“Y by I“geb°7g l- Hodlmair and "15 '‘“'‘d the performance of the adjunctive treatments as well.
by Fan-Gang Zeng and others to increase access. We know
that even under the present conditions, Cls are cost effec- Bm3d‘3"j“gEIigibil"}' “"1 l"di“fi9"5
give oi» highly cost effeeiive in high. and middle. income Even a slight further relaxation in the candidacy criteria, based
countries and are cost effective or approaching cost effective- 011 dim Wfiuld i1'|C1'€’n\59 Subsmmiil-lY the number of P5750115
mess in some of the iower ii-imme eoumi-ies wiih i_i-i-ipmviiig who could benefit from a CI. Evidence for a broadening of eli-
economies (Emmett et al., 2015, 2016; Saunders et al., 2015). Sibl-mY is available l°d“Y (G1-fl"0l‘d 6t al., 2010;Wi1S0D, 2012)-
However, much more could be done to increase-access—es- An immensely large populafion of persons who would be m_
pecially in the middle- and low-income countries—so that eluded as Cmdidmes Wm] me slight relaxation are the sufferers
All may hear, as Bill House. put it years ago, and as was the “presbycusis, which is a sodallyisolafing and mherwise debfli_
motto for the House Ear Institute in Los Angeles (founded by . . . . . .
Bill's half brother Howard) before its demise in 2013 (Shan- mu-lg Condmon‘ There are more than 10 mllhon People m the
United States alone who have this afiliction, and the numbers in
non’ 20 15)" the United States and worldwide are growing exponentially with
Improving Unilateral Cacbleiirlmplzints the ongoing increases in and aging of the worlds populations.
As seen in Figure 3 and as noted by Li.rn et al. (2017) and Zeng A hearing aid often is not effective for presbycusis sufferers be-
(2017), the performance of unilateral Cls has been relatively cause most of them have good or even normal hearing at low
static since the mid-1990s despite many well-conceived efforts frequencies (below about 1.5 kHz) but poor or extremely poor
to improve them and despite ( 1) multiple relaxations in the hearing at the higher frequencies (Dubno et al., 2013). The am-
candidacy criteria for cochlear implantation; (2) increases in plification provided by a hearing aid is geneially not needed at
the number of stimulus sites in the cochlea; and (3) the advent the low frequencies and is generally not effective (or only mar-
of multiple new devices and processing stiategies. Presumably, ginally effective) at the high frequencies because little remains
todays recipients have healthier cochleas and certainly a high- that can be stimulated acoustically there. A better treatment is
er number of good processing options than the recipients of needed. Possibly, a shallowly and gently inserted CI could pro-
the mid-1990s. In the mid-1990s, the candidacy criteria were vide a “light tonotopic touch” at the basal (high-frequency) end
akin to “can you hear a jet engine 3 meters away from you?” of the cochlea to complement the low-frequency hearing that
and, if not, you could be a candidate. Today, persons with sub- already exists for this stunningly large population of potential
stantial residual hearing, and even persons with a severe or beneficiaries.
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