It is easily possible to create a low cost, high quality cochlear implant
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It is easily possible to create a low cost, high quality cochlear implant |
Hearing For Children
Since the first cochlear implant was put in a human patient in 1957, progress has been tremendous:
80,000 cochlear implants is of course exceptionally good. This estimated number of implants means that the miracle of hearing has been provided to tens of thousands of those who, without these remarkable devices, would still be locked in deep silence.
But here is the thing: It seems likely that there are as many as 60 million profoundly bilaterally deaf people in the world, or 120 million deaf ears. There are no accurate worldwide figures— poor countries rarely have the resources for detailed statistical studies of the health challenges faced by their population, and most of the world is poor... But even so, the evidence which is available indicates this number is not outside the realm of reason. Just as the total population of the world is growing, the number of those who are deaf grows, each year, and it also appears based on some studies that the number of those who are deaf increases faster than the general increase in population. It may well be that the deaf population of the world is increasing by more than 800,000 a year.
Consider therefore that 20 years of cochlear implantation, in the best case, has resulted in what is really only a small number of implants: fewer than 10% of the annual net increase in the population of the deaf, worldwide.
20 years of implants 
10%
of one year's worldwide increase
To put it another way, as compared with the number of those who are deaf, worldwide, the cochlear implants have benefited fewer than 1 in every 1,000.
80,000 implants 1
in 1,000 of the world's deaf
The summation is that as yet, we have not made any appreciable progress in reducing the number of those functionally deaf, worldwide. We have made marvelous, even astonishing progress, as it says above. But even given that progress across almost a half century, the number of those who are deaf worldwide has increased, rather dramatically. We have not yet seen the truly widespread use of cochlear implant technology against deafness.
It would seem, therefore that even as present (multiple electrode) cochlear implant technology advances and its results improve, we are providing better and better solutions to fewer and fewer people in need. Global deafness marches on, its growth essentially unchecked.
Until we can reliably and regularly provide enough cochlear implants every year to at least equal the annual increase in the number of those who are deaf, that global population will continue to grow.
Clearly, there are many reasons why someone would not get a cochlear implant. Fear of surgery? Possible loss of any useful residual hearing?
But there is a more important barrier. Consider that the global per capita income in 1999 was around $5,700. And 40% of the world lives on $2 or less per day... Further consider that according to Dr. Niparko and colleagues:
“Using fiscal year 1999 data, lifetime direct medical costs of the implantation and associated services were $60,228.” (link)
Cheng AK, Rubin HR, Powe NR, Mellon NK, Francis HW, Niparko JK. Cost-utility analysis of the cochlear implant in children, JAMA. 2000 Aug 16;284(7):850-6
$60,000 10
years total of the average annual per capita income
In other words, how is it possible to make good progress against deafness when the best present treatment is absolutely unaffordable to the vast majority of those who need it?
Well... That's a complicated question. It does seem as though present designs could be sold less expensively, but even if we imagine that we can cut the price of present technology in half, that's not enough of a reduction.
Here's a way to visualize the problem:
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100,000+ transistors,
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Zero transistors,
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The company which makes the above very complex internal device (picture on the left) for a multiple electrode cochlear implant once reported that it had spent $30 million for research and development of their newest device. If this company sells 10,000 of these new devices over the next 5 to 7 years, then— without considering on-going costs of manufacturing, marketing, salaries, overhead, etc. (and of course not considering profit)— $3,000 of the total cost of every one of those 10,000 devices will simply be the result of this R&D cost, just to achieve breakeven.
This is not a criticism of multiple electrode cochlear implant technology, mind you. As it says above, this technology has provided many benefits. The problem is that it is too expensive, and is certain for many years to remain too expensive for the vast majority of the world's deaf.
That is, other factors aside, multiple electrode cochlear implant technology is unlikely to produce a significantly less expensive device any time soon. Hemmed in by a forest of patents and caught between relatively low sales volumes— as compared with digital wristwatches or refrigerators— and the need to offer new and better units every few years, the complex circuitry used in today's cochlear implants will remain very expensive to research, design, manufacture, and support. They are essentially certain never to get to the point of lowering costs through far higher volumes (as digital wristwatches have done), because the designs will change before that time (just as has been the case with pacemakers).
By contrast, the heart of a single electrode cochlear implant— essentially its only internal part— is a simple, biocompatible coil of wire (picture on the right, above); and a coil of wire can be produced very inexpensively.
Many people believe that single electrode cochlear implant technology cannot provide a quality of hearing which is comparable to that offered by multiple electrode devices. In fact, however, such assertions are apparently incorrect, since there are peer-reviewed results which show that single electrode cochlear implants have provided some patients with a result that is fully comparable to the results which patients using multiple electrode devices have gained. As an example, in one early study of over 100 children using a variety of cochlear implants, one user, “TL” bears mention. She was using a 3M/House cochlear implant whereas most of the other children were using multiple electrode devices:
“ …(TL) is a superior user… Her performance on a modified version of the Glendonald Auditory Screening procedure [was equaled by only] 1.5% of the total 126 subjects…” (link)
Chute PM, Hellman SA, Parisier, SC, Selesnick SH: A
matched-pairs comparison of single and multichannel cochlear implants in
children. Laryngoscope 100 January 1990, p 25-28
In other words, no other child among over 100, using any other cochlear implant, did better than TL. If single electrode implants “don't work”, how is that possible? TL had to be getting good information from somewhere...
Yet other studies show that single electrode designs, on average, did not offer patients as much benefit as multiple electrode designs. What gives?
The story of why single electrode implants, on average, might not have worked as well as competing multiple electrode designs is a long one, and better told elsewhere. The summation, however, is that:
(In the case of the early 3M/House processors, the only frequencies provided were from 340 Hz to 2700 Hz, leaving out approximately 35% of the information useful to the full understanding of English. The sounds of consonants [t, s] would be hard to hear using such a processor, so clearly patients using such processors would not do as well on speech tests…)
(“Clipping” produces distortions in the sound just at the point the signal is finally loud enough. Turn the volume up, more distortion. Turn the volume down its clearer, but harder to hear; not loud enough...)
(A cheap stereo bought at Walmart might have 2% THD, total harmonic distortion, a measure of circuit noise and distortion. Some single electrode processors have 25% THD, more than 10 times as much distortion. Since the majority of deaf patients have a lower tolerance for noise than most of us, added circuit noise can be expected to reduce speech test scores for these patients…)
In fact, we know of no research which has been done that would even indicate— much less prove— that results from early single electrode devices have more to do with the fact that they have a single electrode than with the fact that early processors had the above very serious limits. Indeed, logic and considerable scientific evidence would dictate that improving the processor will improve results, and such improvements could indeed be dramatic...
For the moment, the key point is this:
Even if improvements which offer a better listening experience and more information cannot be made in single electrode cochlear implant technology (an assumption certain to be wrong), having some useful hearing is far, far better than living the the prison of silence. This degree of benefit was part of the proof offered by 3M when it gained FDA approval for its single electrode cochlear implant in 1984: that device was shown to be better than hearing aids, better than sign language... In a word, better than deafness. The choice is not between two kinds of cochlear implants, be clear: The choice is between an affordable cochlear implant and deafness.
A low-cost cochlear implant design, and a clear demonstration that it works well for patients so deaf they cannot use hearing aids, would build worldwide interest in helping these deaf, just as knowledge that it is easily possible to build low-cost hearing aids— such as is being done by David Green— is producing growing interest in low-cost hearing aids... Its called “compassionate capitalism.”
With your help, we can demonstrate that cochlear implants can be made inexpensively, in high quantity with high quality and sold with sufficient profit at a low cost. You and Hearing for Children can show manufacturers and others around the world that it is possible to help the deaf to hear.
We have the opportunity to produce a significant, worldwide, self-funded medical intervention.
Consider donating, please, or if this is not possible for you, at this point, then please consider informing your friends, talking with local organizations such as the Lion’s Club or Kiwanas, or sending us a message of support. It does make a difference to know that there are people of good will interested in the work being done...