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Bilateral Cochlear Implants

When Just One Won't Do

By

Updated January 20, 2010

In the documentary "Sicko" directed by Michael Moore, parents of a deaf child try to get two cochlear implants for their child. The insurance company denies the second implant because it is "experimental." However, the insurance company reverses its denial.

While it is true that some insurance companies may deny coverage for a second cochlear implant, more are covering bilateral cochlear implants. (Medicare covers bilateral implants and so do some Medicaid plans). State legislation in some states requires coverage of bilateral implants if single implants are covered. A mounting body of research demonstrates the benefits of a second cochlear implant, especially for children.

Who Can Get Bilateral Implants

Candidates who meet the insurer's criteria can get bilateral cochlear implants. For example, under Cigna's policy, children (under 18) qualify if they have at least 90 decibels of hearing loss, don't benefit enough from hearing aids, or a hearing aid trial has not worked. For adults, a 70 decibel or greater hearing loss, and limited or no benefit from hearing aids, qualifies. Both ears should also be in good physical condition for implantation, e.g. no ossification (bone growth).

Cochlear implants are expensive. The total cost of one implant is tens of thousands of dollars. Having both implants done simultaneously may be less expensive than implanting one ear and later doing the other ear.

Pros of Bilateral Implants

The basic thinking about bilateral implants is that having two "ears" is better than having only one "ear" to hear with. A person with only one implant is similar to someone with a unilateral hearing loss. Also, if a first implant does not give enough benefit, a second implant may increase the benefit.

Bilateral implants also help with hearing challenges due to having only one implant. For example, a person who can hear out of only one ear may be limited to hearing sound only on the side that has the implant. With two implants, it is easier to find someone who is talking (even if there is background noise), and tell where sound is coming from.

In addition, bilateral implants overcome noisy environments. The dual implants can help filter sounds by blocking "garbage noise," making easier to hear speech.

Cons of Bilateral Implants

One concern about bilateral implants is that cochlear implants may destroy residual hearing. Therefore, the thinking goes, if someone gets bilateral implants today, they may miss out on future improvements in hearing technology. Increased surgical risks (such as meningitis, preventable by vaccination) are also a concern.

Research on Bilateral Implants

Studies have been completed (or are ongoing) on bilateral implants. This research demonstrates that bilateral implants improve listening and communication abilities. These studies show that young children usually get more benefit.

Cochlear implant manufacturers sponsor some of the studies. Advanced Bionics has downloadable PDFs (bibliography and summary) from peer-reviewed publications, of articles on bilateral implants. Cochlear has sponsored studies of simultaneous and sequential implantation in children and adults, and offers PDF downloads.

The advocacy organization Let Them Hear, which has appealed insurance denials for bilateral implants, also maintains a similar bibliography online. For those who may be having difficulty getting their insurance to cover a second implant, the available body of research may help to bolster their appeals.

Discussion on Bilateral Implants

The About.com Deafness blog posting, "Bilateral Implants - New Standard?" reports on a newspaper article about bilateral cochlear implants and raises the question of the fairness of giving deaf children two expensive cochlear implants at a time there are millions of uninsured people.

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About.com reviews of Sicko:

Documentaries Guide Review
Health Insurance Guide Review
World Film Guide Review

Sources:

Advanced Bionics research PDF - http://www.bionicear.com/Professional/Professional_Resources/reimbursement.cfm.

Bilateral Cochlear Implant Hearing Information Center - http://bilateral.cochlear.com.

Let Them Hear bibliography - http://advocacy.letthemhear.org/research.php.

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