Economic Evaluation of Cochlear Implant

INTRODUCTION

[Di – Explain the problem/issue that scientists are trying to solve with the medical technology]

According to World Health Organisation, 466 million people globally are suffering from disabling hearing loss (WHO, 2019) a condition which reduces the individual’s hearing by 30-40 decibels (dB). Patients with this disability have trouble in communicating with others, social situations and partaking in activities involving sound.

The causes of disabling hearing loss may be genetic (from birth) or acquired. Acquired hearing loss is obtained during life because of an accident, exposure to loud noises or from ear infections.

The human ear consists of 3 parts: the outer ear, middle ear and inner ear. The outer ear is where the pinna (part of the ear sticking out of the head) collects the sound waves and directs them down the auditory canal. At the end of the auditory canal there is the tympanic membrane which vibrates according to the frequency and amplitude of the sound wave incident on it. The middle ear consists of three small bones attached in series to the inner side of the tympanic membrane. These bones pick up the vibrations from the tympanic membrane and amplify them. The last bone is connected to the oval window which is another membrane. The inner ear consists of a series of canals with liquid that pick up the vibrations from the oval window. Special hair cells in the cochlea of the inner ear (a spiral looking canal filled with liquid) start oscillating according to the vibrations they receive. The oscillations of these hair cells ultimately generate the electrical signals in the auditory nerve.

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Acquired hearing loss typically causes damage to parts of the middle and/or inner ear. Such damage is very difficult to heal with medical procedures, because the structure of the inner and middle ear are very delicate and surgical operations are risky and challenging.

One modern technology that can help patients with disabling hearing loss regain a partial sensation of hearing is the cochlear implant. Cochlear implants are devices that allow the sound to be transferred from the outer ear directly to the auditory nerve without passing through the damaged part of the middle or inner ear.

SCIENTIFIC UNDERSTANDING

[Di – Explain the science behind your chosen medical technology.

Depending on the medical technology you have chosen, the focus of your response can be on either:

*The science involved in the development of the technology

*The science involved in the implementation (use/application) of the technology

OR a combination of the two]

The cochlear implant acts as a replacement to the damaged part of the middle or inner ear. It does not fully restore a deaf individual’s normal hearing but instead provides them with a useful representation of sound. The implant is a small device that consists of two parts: the external component which includes a microphone, a sound processor and a transmitter system and the internal component which consists of the implanted receiver and electrode array.

Sounds are detected by the microphone, which contains membranes that oscillate according to frequency and amplitude of the waves. Essentially it mimics the function of the tympanic membrane. A sound processor, which is a small digital device situated behind the ear, converts the analogue signal (vibrations in the membrane of the microphone) to a digital signal (based on electricity). This signal is then sent to the transmitter, which is a coil located on the outside of the ear. The transmitter’s job is to generate radio waves carrying the digital signal, in the same wave a radio or TV station antenna transmits the signal in its vicinity.

The signals are picked up by the implanted electrode array. These are thin metallic fibrous threads that have to be implanted surgically and are in contact with the auditory nerve. Once the electrode array receives the radio wave it stimulates the nerve and causes an electrochemical signal to be fired towards the brain, emulating the effect of hearing.

EFFECTIVENESS

[Dii – Discuss and evaluate the effectiveness of the medical technology]

Globally, around 190,000 patients currently have cochlear implants (NIH, 2018). Cochlear implants are particularly useful to people who have sustained middle ear damage or damage to the hair cells in the middle ear. These people would not benefit from traditional hearing aids. The cochlear implant directly stimulates the auditory nerve therefore bypassing the hair cells.

The cochlear implant however, does not help all people with hearing difficulties. It has some limitations including:

• it is different from hearing sound

• it requires the person to learn to interpret the sensations they receive

• it takes time and experience for this to occur.

There are also risks associated with the surgery that requires a general anaesthetic including risks to the facial nerves and the chance of infection.

Cochlear implants have been scientifically shown to be particularly effective when implanted among young children with profound hearing loss, as their brain at a younger age is easier to adapt to the electrochemical signals sent by the electrode array (NIH, 2018). Th

A research study shows that the quality of life of adult and children patients with partial or profound hearing loss has improved between 11%-38% with the use of cochlear implants. Some quality of life factors that have been assessed include: hearing, speech usual activities and distress (Carter, 1999). Similar findings about improvements in quality of life of patients with cochlear implants have been confirmed by multiple other articles (Raman et al., 2011)

Several studies have been conducted and the results have proven that patients with cochlear implants can perceive speech more easily after the implant compared to pre implantation (Raman et al., 2011).

IMPLICIATIONS

[Dii – Discuss and evaluate the implications of applying this medical technology. You must discuss positives and negatives for at least two of the following types of implications]:

[Economic, Environmental, Social, Ethical/Moral]

Economic:

The costs for the cochlear implant for child patients add up to $54,000 for the first year and $1800 per following up year (Raman et al., 2011). A negative factor for the cochlear implant is high capital costs and the continuous costs for managing the implant. The ongoing support and maintenance include: battery changes, wiring fixes of re-mapping of device. However, these costs are relatively lower than the special educational services and care needed for children with deafness without the cochlear implant.

Social:

Patients who have underwent the surgical procedure of installing the cochlear implant have said that their everyday life quality has drastically improved. From being able to better understand speech, using the phone, watching television, and just fitting into society in general. Currently over 300,000 patients around the world have improved quality of life and improved hearing from the cochlear implant (). This means that all these patients can be more engaged members of the society. Some social aspects that can be improved with the help of cochlear implant include: more job opportunities, become more independent in daily activities (shopping, eating out etc.) and also have the ability to be more actively participating in social situations. A detrimental setback the cochlear implant has is that many physical contact sports are hands on and may damage the cochlear implant.

Ethical:

How ethical the cochlear implant is dependent on how well the surgical procedure for installing the device on the patient goes. Another factor to determine how ethical this technology is by looking at the benefits of the cochlear implant which is also dependent on the patient. If the procedure of installing the device finishes without causing any harm to anyone then it would be deemed ethical. But if the operation on the patient fails, causing damage to the patient then it would be considered unethical. There is always a risk towards the patient when installing the cochlear implant because it is never 100% guaranteed to end well. By looking at the benefits of installing the cochlear implant, we can determine if the patient is paying for something that will in some way aid the patient with their hearing and not just for a gimmick. Research states that “Fifty of the 56 respondents stated that they were always or mostly satisfied with their cochlear implant.” (hear-it, n.d). From this statement we can say that the cochlear implant was a successful treatment for improving the quality of life and speech recognition which clearly shows the cochlear implant is an ethical device. Ethical issues related to the cochlear implant may also be the disapproval of human modification on the human body from certain religions and cultures. Another issue is high installation and management costs of the cochlear implants. It goes that wealthy patients may be able to afford the implant without difficulty however middle and low income patients are often excluded from this expensive technology.

ALTERNATIVES

[Di – Describe changes to the medical technology (or an alternative technology) that could address some of the negative implications associated with its use, and explain how these changes would solve or reduce these problems]

Hearing aid, special training (1mil),

REFERENCES

[Div – All sources must be documented here, using APA referencing]

• Carter, R., & Hailey, D. (1999). Economic Evaluation of Cochlear Implant. International journal of technology assessment in health care, 15(3), 520-530.
• Raman, G., Lee, J., Chung, M., Gaylor, J. M., Sen, S., Rao, M., … & Neault, M. W. (2011). Effectiveness of cochlear implants in adults with sensorineural hearing loss.
• https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss
• https://www.fda.gov/medical-devices/cochlear-implants/what-cochlear-implant
• https://www.nidcd.nih.gov/health/cochlear-implants
• https://www.cochlear.com/au/en/home/diagnosis-and-treatment/how-cochlear-solutions-work/
• https://kidshealth.org/en/parents/cochlear.html
• https://advancedbionics.com/us/en/home/products/ci-internal-components.html
• https://advancedbionics.com/au/en/home/about-cochlear-implants.html
• https://www.asha.org/public/hearing/cochlear-implant/
• https://www.scic.org.au/our-clinic/learn-about-cochlear-implants/
• https://www.hear-it.org/cochlear-implants-improve-quality-of-life-3