Cochlear implants are included in Shanghai's medical insurance! A cochlear implant costs 200,000 yuan, why is it so expensive?

Since October this year, cochlear implants have been included in Shanghai's medical insurance, bringing good news to the majority of hearing-impaired patients. However, many people still have many doubts about cochlear implants. What is a cochlear implant? What is the difference between a cochlear implant and a hearing aid? How is a cochlear implant worn? Let's take a look~

01

What is a cochlear implant?

A cochlear implant, also known as an electronic cochlear implant, is an electronic device that is surgically implanted into the patient's ear and is considered one of the greatest medical inventions of the 20th century. The cochlear implant mimics the function of the human cochlea, converting external sound signals (mechanical energy) into nerve signals (electrical signals) . The auditory nerve then transmits this specially encoded electrical signal to the brain, thus reconstructing the patient's hearing function .

Image source: Heilongjiang Provincial Disabled Persons’ Federation

The cochlear implant consists of two parts, the internal and external parts. The external part needs to be worn next to the ear , and includes a microphone, a speech processor, and a battery. The microphone is responsible for receiving sound, and the processor converts the signal. The internal part is implanted into the body through surgery , including the implant and the electrode wire it emits. The implant is surgically buried in the skull bone groove under the scalp and can obtain electrical signals across the scalp. The electrode wire is surgically inserted into the cochlea to transmit the electrical signals to the auditory nerve. The internal implant and the external speech processor attract each other across the scalp and transmit radio signals.

The structure of the cochlear implant Source: Heilongjiang Provincial Disabled Persons’ Federation

02

What is the difference between a cochlear implant and a hearing aid?

Both cochlear implants and hearing aids are devices used to compensate for and improve hearing, but they differ in their working principles and applicable populations. Hearing aids are sound amplifiers that require patients to have a certain degree of basic hearing. Cochlear implants, on the other hand, are sound processors . Sound waves enter the machine, and radio waves are emitted. By replacing a broken "telephone" (human cochlea), the "telephone line" (auditory nerve) connected to it at the back is stimulated, allowing the patient to hear the sound.

Image source: Photo Network

From the perspective of the applicable population, hearing aids are mainly suitable for patients with mild to moderate hearing impairment, and some patients with severe hearing impairment , but they are often of limited effect on patients with severe and profound hearing impairment, and are ineffective for patients with complete deafness. Cochlear implants are suitable for patients with severe, profound or complete deafness . Therefore, those who do not benefit from hearing aids or have little effect may consider cochlear implants. It is worth mentioning that for some patients, cochlear implants have little or no effect due to the loss or lesions of the auditory nerve or auditory center.

Image source: Photo Network

In addition, hearing aids can be worn outside the body, while cochlear implants have an internal part that needs to be surgically implanted into the human body. Hearing aids need to be adjusted regularly after wearing, and cochlear implants require hearing and speech rehabilitation in addition to regular adjustments.

03

A cochlear implant costs as much as a car?

At present, the cost of a single cochlear implant is about 200,000 yuan. After it is included in the medical insurance, the insured person will first pay 20% of the cost of using Class B consumables in cash, and the rest of the cost can be paid according to the Shanghai Basic Medical Insurance regulations. Why are cochlear implants so expensive? It is mainly due to the following reasons:

High R&D costs

The cochlear implant is a high-tech product. The R&D team includes experts from multiple fields. The R&D cycle is long and requires a large amount of money to be invested in R&D, testing, and production to meet the needs of product upgrades and improvements.

High production cost

The products are highly technical, including highly sealed implants, independent power supplies, electrode design, processing technology, immune materials, battery control, speech program processing, sound program, etc. They also involve the power saving, durability, waterproofness, wearing methods, etc. Most of the raw materials can only be provided by top suppliers.

High costs for clinical trials and approvals

Cochlear implants need to go through a large number of clinical trials and approval procedures to ensure their safety and effectiveness, a process that also requires a lot of time and financial investment.

Delicate surgery and regular maintenance

Cochlear implant surgery is delicate and requires regular equipment maintenance after surgery, as well as long-term hearing and speech rehabilitation training.

04

Cochlear implant implantation and wearing

The implantation of a cochlear implant requires surgery by an otolaryngologist and head and neck surgeon . The surgery does not require opening the skull, but requires grinding a bone groove in the skull behind the ear to "make" a "pocket" to accommodate the stimulation receiver, expose the cochlea, and insert the electrode into the cochlea.

Image source: Medical community

When worn, the external component is placed behind the ear and connected to the internal implant through magnetism. The external component is charged regularly so that it can work. The surgically implanted internal component usually will not be lost. If the external component is lost, it needs to be replaced separately without the need for another surgery.

Schematic diagram of wearing a cochlear implant Source: sohu

Some people may ask, can I have an MRI after having a cochlear implant? This mainly depends on the model and design of the cochlear implant. Currently, there are cochlear implants that are compatible with MRI examinations on the market. Before having an MRI, you need to consult your doctor or the device manufacturer. In addition, cochlear implant patients need to pay attention to the following matters :

(1) After the cochlear implant is placed, care should be taken to protect the internal parts from damage or infection . Avoid violent head impacts to prevent damage to the implant site or subcutaneous hematoma. At the same time, the implant site should be kept clean and dry.

(2) The external part of the cochlear implant needs to be cleaned and maintained regularly to ensure normal operation. Clean the microphone, sound processor, battery and other equipment regularly to keep them dry and clean. At the same time, replace parts regularly according to the doctor's advice to maintain the normal operation of the cochlear implant.

(3) Patients need to undergo regular hearing assessments and adjust the parameters of the cochlear implant to ensure the best hearing effect.

(4) Cochlear implants can improve patients' hearing, but they cannot restore patients' hearing to completely "normal" or "natural" levels. The transition from "hearing" to "understanding" also requires a rehabilitation process . For patients with post-lingual deafness (deafness after learning to speak), rehabilitation after cochlear implant will allow them to quickly adapt and restore their hearing and speech functions; but for patients with pre-lingual deafness (deafness before learning to speak), longer rehabilitation training is required. Shanghai has included cochlear implants in medical insurance, which means that more hearing-impaired patients will have the opportunity to enjoy the benefits of this high-tech, restore their hearing and speech, and return to and integrate into the beautiful world of sound. References

[1] NIH. (2017). Cochlear Implants. National Institute on Deafness and Other Communication Disorders.

[2] Gifford RH, Shallop JK, Peterson AM. (2008). Speech recognition materials and ceiling effects: considerations for cochlear implant programs. Audiol Neurootol.

[3] Clark, GM (2006). The multi-channel cochlear implant: multi-disciplinary development of electrical stimulation of the cochlea and the resulting clinical benefit. Hear Res.

[4] Roland JT Jr. (2005). A model for cochlear implant insertion electrode and force evaluation: results with a new electrode design and insertion technique. Laryngoscope.

[5] Carlson ML, et al. (2012). Cochlear implantation: current and future device options. Otolaryngol Clin North Am.

[6] FDA. (2020). MRI Scans of Patients with Cochlear Implants. US Food & Drug Administration.

Author: Graduate student Ye Cheng from the Affiliated Eye, Ear, Nose and Throat Hospital of Fudan University; Resident physician Wang Jiali; Chief physician Shu Yilai Editor: Xiao Dingdang