Euro-CIU symposium: Science and technology advance, society lags behind

The tenth EURO-CIU symposium in Antwerp on 10 April provided an excellent opportunity to become aware of the state of affairs regarding cochlear implants in Europe. The venue was organized by ONICI, the Belgian / Dutch independent association for information on cochlear implantation in cooperation with Euro-CIU, the European association of users of cochlear implants.The speakers commented from different perspectives on the topic. All facets put together offered an excellent outlook on the history of CI, the current situation and the future.

Monika Lehnhardt of the German Lehnhardt Foundation looked back on three decades of CI application and saw huge development: "In the beginning, application was limited to younger, completely deaf people. Nowadays two cochlear implants for people with residual hearing is not unusual and people ranging from six months to 91 years are fitted with them. This enlarged indication is the big change." In addition, there has been considerable technological progress and adaptation to the individual patient has greatly improved. “In my view, CIs in twenty years will be small, inexpensive, fully implantable, online serviceable and user programmable."

The boundary shifts

Professor Frans Coninx of the Institut für Audiopädagogik in Solingen (Germany) looks in more detail at the shifting frontier between CI and hearing aids. "Initially, a CI was intended to support lip reading. Now, the enhanced sound processing, improved surgery and fitting protocols open up a much larger potential scope." Evidence-based medicine, including speech-in-noise tests, learns that about 50 dB hearing loss can be the threshold between hearing aid application and CI application. Large scale data collection about this will start this year in the German-speaking countries.

Pennywise, pound foolish

Dr. Sue Archbold of the British Ear Foundation in Nottingham focuses primarily on the quality of life of cochlear implant users in Europe. "The impact of deafness among adults is not sufficiently recognized," she starts. The problem is not just big, it is also growing. "According to the WHO, hearing loss will become a top ten disease burden in 2030. It hits ten million Britons, 41% of people over fifty suffer from hearing loss. We have great technology, but is all well? No. Britons wait ten years before they seek help and only 7% of the people who would benefit from CIs are actually fitted." That's a pity, because a survey among 552 Euro CIU users points out that 475 users are "very satisfied" or "satisfied" with their CI. The majority is always understood by others and uses the telephone.

A major problem right now is the financial pressure on health systems across Europe. "In Britain the direct cost of treatment for hearing loss amounts to 450 million pounds.” In the desire to make budget cuts, the indirect costs as a consequence of depression, increased dementia, unemployment and so on, amounting to 30 billion pounds tend to be forgotten. “Treatment is extremely cost-effective. The question is not whether we can afford to give people CIs, the question is whether we can afford not to."

Unite!

Professor Hendrik Fehr of Euro-CIU and Universität Trier regrets the lack of unanimity among the European deaf and hard of hearing. “It is unfortunate and disastrous for the European lobby by the deaf community that it seems not to be able to speak with one voice. Thus European politicians conclude: 'what can we do with such a mixed message?' Let's reason from what we have in common and not linger in our own domain."

Early implantation

Dr. Peter Baumhoff is a researcher at the Medische Hochschule Hannover (MHH) and presents recent research on the development of the brain, the consequences of the lack of auditory signals and cochlear implants. Early implantation is vital, his recent animal model research learns. When deaf cats are implanted within three months after birth – comparable to two to four years for humans - the brain later hardly differs from that of normal hearing cats. After six months, this time window has almost completely closed. Synapses have been formed, but go away again when they don't receive audio signals: functional recovery is becoming increasingly difficult.

Practical progress

Rehabilitation Manager EMEA at Cochlear, Clare Sheridan, doesn't look inside the brain. She listens mostly to individual CI users. She emphasized how important it is to 'liberate the expert in the individual patient.' "Everyone has unique experiences that help shaping personal characteristics and competencies. That deserves recognition and respect." Her advice to clinicians: listen carefully to the patient and remove his restrictions. "Promoting optimism is important, as is the goal that the patient sets for himself.”

Much less tinnitus

Dr. Vincent Van Rompaey of the University of Antwerp has been investigating the use of CI in asymmetrical hearing loss (or Single Sided Deafness, SSD). 40% within this SSD population also suffer from tinnitus. Van Rompaey: "Thanks to CI, their tinnitus intensity decreases from eight to two on a scale of ten. And this happens fast: the result is reached within a month after fitting and also holds on when the CI is turned off. This result remains stable for at least eighteen months." Speech understanding in noise, spatial hearing and the overall hearing performance all improve thanks to CI in acquired unilateral deafness. This article can only show a glimpse of the contents of the Euro-CIU symposium on April 10th.

But there is a clear tendency: scientific understanding and technological and medical options have increased dramatically over recent decades. The vast majority of CI users is very satisfied at present. All the more bitter it is, that only part of the people who would benefit from a cochlear implant actually receive one or two. Especially in the societal field there is still much progress to be made.

Leendert Van der Ent, editor in chief Audiology Infos The Netherlands