Impact on surgical costs and risks Adoption of cochlear implants

Fear of cost and lack of insurance coverage have been identified as major concerns for patients considering cochlear implant surgery.


“The safety and effectiveness of cochlear implants (CIs) have improved dramatically over the past 30 years, but the rate of eligible adults who receive a cochlear implant has remained below 10%, according to most studies,” said Francis Creighton, MD, Remarks. “Furthermore, there is a growing body of evidence showing that untreated hearing loss in patients leads to higher rates of cognitive decline and other comorbidities. Given this, there is significant public health interest in understanding and improving the low penetrance rate of CIs in eligible adults.

Research in this area has primarily looked at intrinsic patient factors that make individuals more or less likely to get an implant, such as socioeconomic status, geographic proximity to surgical specialists, or patient education level. , according to Dr. Creighton. “While this work is important, we felt that a better understanding of the preconceived opinions and knowledge of the general public about cochlear implantation, its low penetrance rate and their associated risks and benefits is necessary to better understand the low rates cochlear implantation therapy in eligible adults.

For a study published in Otology & Neurotology, Dr. Creighton and colleagues asked participants about their perceptions of cochlear implantation. Respondents were asked to rank the overall CI QOL-10 priorities and associated tolerance for minor and major complications.

Low adoption driven by perception of surgical costs and risks

The study included 615 respondents (55% female; mean age, 39 years). Insurance issues (46%) and concerns about surgery (21%) were cited as barriers preventing eligible adults from receiving a CI.

“Fear of cost and lack of insurance coverage were identified as major concerns for patients and considered possible reasons for low penetrance rates,” says Dr. Creighton. “In fact, all major insurance companies in the United States, as well as Medicare and Medicaid, cover cochlear implants in patients who meet audiological criteria.”

In terms of surgical risk, respondents greatly underestimated the rates of minor complications (PPPP

“Individuals had a very low risk tolerance for minor or major complications, which I think for the otolaryngology community helps to underscore the fact that while these surgeries are generally very well tolerated, an improvement additional surgical safety is needed to help allay fears,” says Dr. Creighton. “Interestingly, people who were in healthcare or knew people with IC were much more likely to tolerate risk, which helps reinforce the idea that better hearing can improve quality of life.”

Specific complications examined by the researchers included taste changes and dizziness, as well as meningitis, facial paralysis and cerebrospinal fluid leakage. (Table). “The American population has very high standards when it comes to surgical procedures, and cochlear implantation is no exception,” notes Dr. Creighton. “As a society, we expect excellence from our surgeons, and while most surgeons, myself included, believe that cochlear implantation is extremely safe, we must continue to push the boundaries to reduce even minor complications. where and however we can. We have made significant progress over the past decades, and I hope this can motivate us to continue this trend.

Further research needed to increase CI adoption

According to Dr. Creighton, one of the main lessons of this study is that the use of CIs remains very low. He also notes that people interested in CIs don’t have to be “deeply deaf” to be a good candidate for them. “It can significantly help with speech in noise as well as sound localization, which this study suggests is an important priority for the public when it comes to hearing quality of life.”

Dr. Creighton notes that future research should focus on strategies to continue to improve the safety of cochlear implantation surgery through technological advances that incorporate robotics, image navigation and artificial intelligence, and examine which Patient and surgeon factors, such as volume, experience, and geographic location, can predict better or worse results. “I would also like to see more work done to better delineate decision tree analyzes and patient guides for people with hearing loss who are considering cochlear implantation,” he says.

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