Why shouldn't I wait for better cochlear implant technology?

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Dr. Chad Ruffin

ENT Doc and CI Surgeon

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Why shouldn't I wait for better cochlear implant technology?

Waiting for better cochlear implant technology is unadvisable for four reasons:

(1) Hearing circuits atrophy the longer you wait with poor hearing,

(2) Transformational improvements in technology are not on the horizon,

(3) Recent, but well-established research shows that hearing loss is bad for your health, and

(4) it will be decades before inner ear regeneration therapies can restore hearing.

Most of the gains in hearing with cochlear implants over the years has come from implanting patients with better hearing than in the past. This makes sense–greater hearing means that the "hearing circuits" are still intact and working. When speech perception with hearing aids gets closer to zero, this means that parts of the hearing circuits are wearing out. Worn out circuits means that (1) a cochlear implant can't transmit its signal to the speech centers in the brain and (2) the brain is less able to convert the sound into the words of language.

Waiting for better technology is not a great bet. In the last few decades, gains from technology have been rather incremental. Substantial improvements over the next decade will be from software and external hardware updates. The internal hardware has not been the limiting factor in adopting new technology. It will be decades before inner ear regeneration therapies can restore the damaged inner ear structures. Dr. Ruffin is very active in the research community and does not foresee major upcoming changes. Most cochlear implant candidates do not realize this and wait on average 12 years before getting their implant.

This is not advised because untreated hearing loss has profound health consequences. Children with severe hearing loss are at risk for poor language skills and life achievement. Evidence clearly shows that early intervention is critical. This is because children do not learn language well after the age of 6 years. Adults with untreated hearing loss have poorer health outcomes. The risk for cognitive decline or dementia with untreated/undertreated hearing loss is high--between 1 and 9% of patients with hearing loss are at risk for cognitive decline and dementia.

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