Cochlear Implantation
Part One - Support of HOA for Cochlear Implantation Procedures
1- Approximately 3,000 children with severe congenital hearing loss or deafness are born in the country annually, of which about 2,000 cases benefit from hearing through cochlear implantation surgery (other patients are not considered suitable candidates for cochlear implantation for various reasons, including anatomical abnormalities of the ear or severe mental retardation). By performing this surgery, the deaf child, by going through a natural developmental process - like their other peers - will have the opportunity to continue their education in regular schools.
2- The best age to perform cochlear implantation is before the age of 4; however, the age limit mentioned does not mean that the surgery will be ineffective after 4 years of age, but according to statistical reports, after this age, the chance of success of cochlear implantation decreases and to achieve desirable effects, more hearing rehabilitation sessions and more cooperation from parents are required.
3- Cochlear implantation surgery began in Iran in 1993, and HOA, as the largest supporter of cochlear implantation surgeries in the country, has supported more than 19,000 cochlear implantation surgeries since the beginning of these procedures in the country by providing free cochlear implants for deaf patients who are candidates for cochlear implantation, and with the support provided by HOA for cochlear implantation surgeries, the number of surgeries has increased from 174 surgeries in 2008 to 1885 surgeries in 2023, and the number of implantation centers has increased from three centers in 2005 to 16 centers by the end of 2023.
4- Considering the policies of the Ministry of Health, to expedite and facilitate the handling of the problems of deaf patients who are candidates for cochlear implantation surgery and to minimize the waiting list for the mentioned surgery, the National Plan for the Transformation of Cochlear Implantation began in early September 2022, and it was decided that in addition to providing free cochlear implants by HOA, other costs of implantation procedures, including hospital hoteling costs, surgical team fees, and the cost of speech therapy and hearing rehabilitation sessions in the first year after implantation, will be covered by the Ministry of Health, and the implantation procedure for the first ear of deaf patients will be free of charge in public centers.
5- With the start of the implementation of the cochlear implantation transformation plan, with the double efforts of the staff of the relevant units in HOA and the speeding up of the process of managing the distribution and issuance of delivery vouchers for cochlear implants, in 2022, 1892 and in 2023, 1885 cochlear implants were distributed among 16 public and affiliated non-governmental cochlear implantation centers across the country, and during the past three years, a total of 5207 cochlear implant devices were delivered to cochlear implantation centers across the country.
6- Support of the Board of Trustees for the replacement of the hearing processor: The cochlear implant has two parts, the implantable part (inside the ear) and the hearing processor (external), the half-life of the external processor is ten years and after this period it needs to be replaced, and after the mentioned time has passed, if it is not replaced, the probability of the processor malfunctioning increases significantly and this issue causes the patient to lose contact with the outside world, which results in disruption in the individual and social life process, including the inability to attend the educational unit.
7- Considering that the prospect of implementing the cochlear implantation transformation plan is to expedite and facilitate the handling of the problems of deaf patients who are candidates for cochlear implantation surgery and to create satisfaction among the noble families of these patients, after reviewing by HOA in the Treatment of Patients, one of the cases of dissatisfaction of the families of patients with the process of cochlear implantation in the country has been the lack of possibility of replacing old processors (with a half-life of more than ten to fifteen years) and the problems and issues arising from the disruption or cessation of the function of these processors. According to the statistics obtained from cochlear implantation centers across the country and the representative companies of the prosthesis manufacturers, 2,600 cochlear implanted patients who have passed more than 10 to 15 years since their cochlear implantation surgery were identified as eligible for processor replacement, and with the provision of these processors by HOA, their distribution began in August 2023.
8- The sixteen public centers for performing cochlear implantation surgeries are as follows:
- Tehran University of Medical Sciences - Amir A'lam Hospital, Tehran
- Shahid Beheshti University of Medical Sciences - Loghman Hakim Hospital, Tehran
- Iran University of Medical Sciences - Hazrat Rasoul Akram (PBUH) Hospital, Tehran
- Baqiyatallah University of Medical Sciences - Hazrat Baqiyatallah Al-Azam (AJ) Hospital, Tehran
- Mashhad University of Medical Sciences - Hazrat Ghaem (AJ) Hospital, Mashhad
- Shiraz University of Medical Sciences - Khalili Hospital, Shiraz
- Isfahan University of Medical Sciences - Hazrat Fatemeh Zahra (SA) Hospital, Isfahan
- Tabriz University of Medical Sciences - Hazrat Imam Reza (AS) Hospital, Tabriz
- Ahvaz University of Medical Sciences - Imam Khomeini (RA) Hospital, Ahvaz
- Kerman University of Medical Sciences - Shafa Educational and Therapeutic Center, Kerman
- Hamadan University of Medical Sciences - Besat Super Specialized Hospital, Hamadan
- Babol University of Medical Sciences - Ayatollah Rouhani Hospital, Babol
- Kermanshah University of Medical Sciences - Imam Khomeini (RA) Hospital, Kermanshah
- Guilan University of Medical Sciences - Amir Al-Momenin (AS) Hospital, Rasht
- Zahedan University of Medical Sciences - Al-Zahra (SA) Super Specialized Hospital, Zahedan
- Yazd University of Medical Sciences - Shahid Rahnemoon Hospital, Yazd
9- In the above sixteen centers, scientific commissions consisting of ENT surgeons, audiologists, speech therapists, and clinical psychologists, by holding regular meetings based on the clinical and paraclinical evidence and documents provided, evaluate the necessity of performing cochlear implantation in each patient.
10- Considering that after performing cochlear implantation surgeries, patients should participate in speech therapy and hearing rehabilitation sessions for at least one year, referring to the cochlear implantation center in the province of residence or in neighboring provinces will reduce the problems related to accommodation and travel expenses. Fortunately, the national distribution of cochlear implantation centers is currently such that from the northwest (Tabriz) to the southeast (Zahedan) and from the northeast (Mashhad) to the southwest (Ahvaz) and central areas (Tehran, Isfahan, Shiraz, Kerman) are covered by these center
11- Currently, performing each cochlear implantation surgery costs six hundred million Rials, which includes the following:
- The cost of purchasing the hearing prosthesis
- Hospital hoteling costs
- The cost of the surgical team
- The costs of holding speech therapy and hearing rehabilitation sessions in the first year after cochlear implantation surgery.
12- HOA in the Treatment of Patients, based on the objectives set forth in its formation law, in order to provide the opportunity for more patients, especially deprived and needy patients, to use this opportunity, by providing free cochlear implants, supports deaf patients who are candidates for these procedures.
13- It is noteworthy that, according to national statistics, the cost of supporting a deaf person with an average age of 65 years will be more than 8,000,000,000 to 10,000,000,000 Rials for the country's public budget, while by performing cochlear implantation surgery with a cost equivalent to one-sixteenth to one-twentieth of the above cost, not only will savings be made in the country's budgetary costs, but also by performing this surgery, the deaf child will be completely rehabilitated and will be able to enjoy a completely normal life like their other peers.
14- The number of cochlear implant surgeries supported by HOA between the years 1393 and 1402 is as follows:
