Usage approximately 188,000 individuals had been fitted with cochlear implants worldwide. the same publication cited approximately 324,000 cochlear implant devices having been surgically implanted. In the U.S., roughly 58,000 devices were implanted in adults and 38,000 in children. the Ear Foundation in the United Kingdom estimates the number of cochlear implant recipients in the world to be about 600,000. The
American Cochlear Implant Alliance estimates that 217,000 people received CIs in the United States through the end of 2019.
Cost and insurance Cochlear implantation includes the medical device as well as related services and procedures, including preoperative testing, the surgery, and aftercare that includes audiology and speech language pathology services. These are provided over time by a team of clinicians with specialized training. All of these services, as well as the cochlear implant device and related peripherals, are part of the medical intervention and are typically covered by health insurance in the United States and many areas of the world. These medical services and procedures include candidacy evaluation, hospital services inclusive of supplies and medications used during surgery, the surgeon and other physicians such as anesthesiologists, the cochlear implant device and system kit, and programming and (re)habilitation following the surgery. In many countries around the world, the cost of cochlear implantation and aftercare is covered by health insurance. However, financial factors impact the evaluation selection process. Children with public health insurance or no health insurance are less likely to receive the implant before 2 years old. In the US, as cochlear implants have become more commonplace and accepted as a valuable and cost effective health intervention, insurance coverage has expanded to include private insurance,
Medicare,
Tricare, the VA System, other federal health plans, and
Medicaid. In September 2022 the
Centers for Medicare & Medicaid Services expanded coverage of cochlear implants for appropriate candidates under Medicare. Candidates must demonstrate limited benefit with appropriately fit hearing aids, but with criteria now defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence recognition. Just as there is with any medical procedure, there are typically co-pays, which vary depending upon the insurance plan. in
Ireland, Seguridad Social in
Spain, Sistema Sanitario Nazionale in
Italy,
Social security in
France,
Bituah Leumi in
Israel, and the Ministry of Health or
ACC (depending on the cause of deafness) in
New Zealand. In
Germany and
Austria, the cost is covered by most health insurance organizations.
Public health 6.1% of the world population live with hearing loss, and it is predicted that by 2050, more than 900 million people around the globe will have a disabling hearing loss. According to a WHO report, unaddressed hearing loss costs the world 980 billion dollars annually. Particularly hard hit are the healthcare and educational sectors, as well as societal costs. 53% of these costs are attributable to low- and middle-income countries. The WHO reports that cochlear implants have been shown to be a cost-effective way to mitigate the challenges of hearing loss. In a low-to-middle-income setting, every dollar invested in unilateral cochlear implants has a return on investment of 1.46 dollars. This rises to a return on investment of 4.09 dollars in an upper-middle-income setting. A study in Colombia assessed the lifetime investments made in 68 children who received cochlear implants at an early age. Taking into account the cost of the device and any other medical costs, follow-up, speech therapy, batteries and travel, each child required an average investment of US$99 000 over the course of their life (assuming a life span of 78 years for women and 72 years for men). The study concluded that for every dollar invested in rehabilitation of a child with a cochlear implant, there was a return on investment of US$2.07. As of June 2023, Oticon Medical changed ownership to Cochlear Ltd. In Europe, Africa, Asia, South America, and Canada, an additional device manufactured by
Neurelec (later acquired by Oticon Medical) was available. A device made by
Nurotron (China) was also available in some parts of the world. Each manufacturer has adapted some of the successful innovations of the other companies to its own devices. There is no consensus that any one of these implants is superior to the others. Users of all devices report a wide range of performance after implantation.
Criticism and controversy Much of the strongest objection to cochlear implants has come from within the
deaf community, some of whom are pre-lingually deaf people whose first language is a
sign language. Some in the deaf community call cochlear implants
audist and an affront to their culture, which, as they view it, is a minority threatened by the hearing majority. This is an old problem for the deaf community, going back as far as the 18th century with the argument of
manualism vs. oralism. This is consistent with medicalization and the standardization of the "normal" body in the 19th century, when differences between normal and abnormal began to be debated. It is important to consider the sociocultural context, particularly in regard to the deaf community, which has its own unique language and culture. This accounts for the cochlear implant being seen as an affront to their culture, as many do not believe that deafness is something that needs to be cured. However, it has also been argued that this does not necessarily have to be the case: the cochlear implant can act as a tool deaf people can use to access the "hearing world" without losing their deaf identity. Children who have had confirmed severe hearing loss can receive the implant as young as 9 months old. Evidence shows that deaf children of deaf parents (or with fluent signers as daily caregivers) learn signed language as effectively as hearing peers. Some deaf-community advocates recommend that all deaf children should learn sign language from birth, but more than 90% of deaf children are born to hearing parents. Since it takes years to become fluent in sign language, deaf children who grow up without amplification such as hearing aids or cochlear implants will not have daily access to fluent language models in households without fluent signers. Critics of cochlear implants from deaf cultures also assert that the cochlear implant and the subsequent therapy often become the focus of the child's identity at the expense of language acquisition and ease of communication in sign language and deaf identity. They believe that measuring a child's success only by their mastery of speech will lead to a poor self-image as "disabled" (because the implants do not produce normal hearing) rather than having the healthy self-concept of a proudly deaf person. However, these assertions are not supported by research. The first children to receive cochlear implants as infants are only in their 20s (as of 2020), and anecdotal evidence points to a high level of satisfaction in this cohort, most of whom don't consider their deafness their primary identity. Children with cochlear implants are most likely to be educated with listening and spoken language, without
sign language, and are often not educated with other deaf children who use sign language. Cochlear implants have been one of the technological and social factors implicated in the decline of sign languages in the developed world. Some Deaf activists have labeled the widespread implantation of children as a
cultural genocide. As the trend for cochlear implants in children grows, deaf-community advocates have tried to counter the "either or" formulation of
oralism vs.
manualism with a "both and" or "bilingual-bicultural" approach; some schools are now successfully integrating cochlear implants with sign language in their educational programs. However, there is disagreement among researchers about the effectiveness of methods using both sign and speech as compared to sign or speech alone. Another point of controversy made by advocates are that there are racial disparities in the cochlear implantation evaluation process. Data taken from 2010-2020 at one academic tertiary care institution showed that 68.5% of patients referred for evaluation were White, 18.5% were Black, and 12.3% were Asian; however the institution's main service area was 46.9% White, 42.3% Black, and 7.7% Asian. It was also shown that the Black patients who were referred for evaluation to receive the implants had greater hearing loss compared to White patients who were also referred. Based on this study, it is shown that Black patients receive cochlear implants at a disproportionately lower rate than White patients. An additional criticism involves the cost of implant upgrades. The manufacturers introduce new models on a regular basis and stop servicing older models. When this happens, a user who wishes to ensure continued functioning of the implant is required to buy new equipment. This was evident in India for impoverished families whose children received cochlear implants. == Notable recipients (partial list) ==