Even a doctor who has done bilateral implants says there is not enough evidence to show whether the second implant makes a great difference.

01:00 AM EST on Monday, November 21, 2005

BY FELICE J. FREYER
Journal Staff Writer

Is it worth the expense and risk to put cochlear implants in both ears?

Brian J. Hubbard, a deaf-blind man in Newport, calls his bilateral cochlear implants a "miracle" that transformed his life, offering much greater benefit than a single implant.

But others say the jury is still out on the value of double implants. A key concern is cost, and whether a second implant makes a big enough difference.

Each of Hubbard's implants at the UMass Memorial Medical Center cost about $45,000 (in other parts of the country the price can be higher). Because he is disabled, Hubbard is covered by the federal Medicare program, and in his case Medicare paid for both implants.

Medicare regulations specify that the program will cover one cochlear implant in patients who meet certain criteria concerning their hearing loss and ability to adapt. But Medicare doesn't have an established nationwide policy on double implants, and other Medicare beneficiaries -- including people who are both deaf and blind -- have been unable to obtain a second one.

"To me, it doesn't make any sense," said Lorie Singer, vice president of the Cochlear Implant Association (a division of the Maryland-based Hearing Loss Association of America, a patient advocacy group). "If you lose both of your arms, you get two prostheses."

Some studies have shown that deaf people with two implants do better at hearing speech in noisy environments, and also are much better able to tell where sound is coming from, compared with those who have only one.

A small number of implant users are blind as well as deaf. They argue that they have an especially great need for two implants. Knowing where the sound is coming from can be essential to simple tasks such as safely crossing a street, they say.

But Dr. Steven A. Telian, medical director of the Cochlear Implant Program at the University of Michigan Medical School, says that bilateral implants do not make sense in our current health-care system.

Telian has studied the use of cochlear implants in blind people. "The benefits of the first implant are immense. The second is incrementally much smaller," he said.

Most implant centers barely break even with the reimbursement they receive for the implant surgery and especially for the follow-up care that patients require, Telian said.

"From a public health standpoint, it's not possible," he said. "Health care costs are skyrocketing as it is. Insurers play this as a zero-sum game. If somebody gets two implants, somebody else gets zero."

Even Dr. Daniel J. Lee, the surgeon who put the two cochlear implants in Brian Hubbard, is cautious about bilateral implants, saying the benefits are still under study. His program has done bilateral implants in only six or seven adults, he said. Are they worth it?

"We don't know," Lee said. "That's why we're doing a very select number of patients and really trying to study them as well as we can. . . .

"The preliminary evidence does suggest there may be some improved benefit for some patients. In the end we need to really ensure that patient selection is appropriate and careful, and that we use limited resources to take care of patients who haven't even received their first implant."

Lee believes a bilateral implant was the right choice for Brian Hubbard, however.

"The guy's pretty amazing," he said. "He's unique. The way he's been able to compensate for his loss of vision and loss of hearing -- it's really remarkable. He certainly is an inspiration. . . .

"We were pleased to be able to give him back at least some ability to connect with the world, make his life a little easier and a little safer."