Prioritization of Reimplantation in Previously Successful Cochlear Implantation Following Natural Device Failure

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
Jordan HochmanBonnie Cham

Abstract

Cochlear reimplantation procedures account for approximately 5% of all implant cases and may be caused by internal device failure, skin flap complications, or an unexpected decline in auditory performance. This issue, in concert with changing demographics, expanded audiometric candidacy criteria, adult bilateral implantation, and implantation for unilateral hearing loss, all place escalating pressure on device availability and resource allocation in a publically funded health care system. The predictable and problematic access to a scare medical resource requires rigor in establishing program priority and formal policy. We present a single cochlear implant center's working reflections and an attempt at a principled approach to rationing health care decisions. Different approaches to health care rationing are examined and discussed. We describe a method of allocation that is currently employed by a large Canadian quaternary care center and ground this method in important principles of distributive justice as they apply to health care systems. We elect to recognize device failure as analogous to sudden sensorineural hearing loss, with the associated need to expedite reimplantation. We consider this an ethical approach grounded in...Continue Reading

References

Jul 15, 2005·Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology·Amy-Anne Donatelli LassigSteven A Telian
Nov 16, 2013·Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology·Jumin SundeJohn L Dornhoffer
Jun 28, 2016·Current Opinion in Otolaryngology & Head and Neck Surgery·Brendan P O'ConnellDavid S Haynes
Oct 25, 2017·Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology·Ashish VashishthMario Sanna
Dec 12, 2017·Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology·Ashish VashishthMario Sanna

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