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Cochlear Implants in Children: Ethics and Choices

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Since parents were also asked to describe the circumstances of each upgrading or replacement, it is possible to estimate the number of devices that had to be replaced internally. There were 438 responses to the GRI survey that indicated a specific type of implant received by their child.[2] From the comments made by parents, it is apparent that at least 25 (approximately 6%) of these implants had to be replaced internally one time. This is a conservative number since we only counted those comments in which there was clear, unambiguous evidence that it was the internal component that had to be replaced (e.g., comments such as “implant failed, internal failure” or “internally failed, was replaced as outpatient”). If there was any doubt about whether it was an internal or an external piece that needed to be replaced, we assumed that it was an external part. Thus, because of the ambiguity of a number of comments from parents on the GRI survey, it is likely that at least several additional devices needed to be internally replaced. In any case, this is somewhat more than the 1–2% device failure/replacement rate commonly cited by implant companies, although it is less than the 10% replacement rate cited by one of the parents we talked with whose son was implanted three times.

INTERVIEWER: What percentage of devices fail, do you have any idea?  

FATHER: The doctor in [city] who did the third implant said the literature you get from Cochlear and Clarion say they’re 99%; he said actually it’s like 90% . . . . So that’s one in ten [that] will fail.

Father of a young boy implanted three times 

The GRI survey also asked parents if the device had to be replaced or upgraded more than once. Again, using a very conservative estimate, it is apparent that at least nine (2%) respondents needed to replace the internal device twice and at least one (less than 1%) needed to replace the internal unit three times.[3]

2. Devices manufactured by Cochlear Corporation (Nucleus) were used by 358 children, implants manufactured by Advanced Bionics (Clarion) were used by 70 children, and implants from other companies (3M/House and Med El) were used by 10 children. One respondent did not specify the type of implant used. Most of the parents of the children we talked with also used Nucleus devices (Nucleus 22 or the newer Nucleus 24 model), which have been available for a considerably longer period of time than Clarion. Among the families we interviewed, the ratio of Nucleus to Clarion users was about 5:1; no implants made by other manufacturers were used by the children in the families we talked with. For many families included in both the GRI study and in our interviews, the Nucleus device was the only one generally available when their child was implanted. When a choice was available, many parents spent a considerable amount of time weighing the pros and cons (both cosmetic and technological) of each model

3. On this point, a recent article in the Health section of The Washington Post (Colburn, 2000) entitled “Wired for Sound,” includes a sidebar with the heading: “Cochlear Implants at a Glance.” The following appears as a “caveat” in the sidebar: “In about 5 percent of cases, reimplantation is necessary because the original device fails.” No source is given for this information, but it is interesting that the percentage is very close to what is reported in the GRI study.