{
 "schema": 1,
 "id": "cochlear-implant",
 "type": "procedure",
 "names": {
  "name": "Cochlear implant",
  "aliases": [
   "CI",
   "cochlear implantation",
   "auditory prosthesis"
  ],
  "said": "Audiologists say the implant for the part inside the head and the processor for the part outside, and the distinction is the whole economics of the device: the implant is bought once, the processor is bought again and again."
 },
 "etymology": {
  "root": "cochlea: Latin, from Greek kokhlias, a snail with a spiral shell — the spiral bone of the inner ear the electrode array is threaded into. Implant: Latin in- plus plantare, to plant in.",
  "tier": "tradition",
  "note": "mapping, or programming, is the audiologist's word for setting the current level on each electrode. It is not a repair and it is not optional; a map drifts, and a child's changes as they grow."
 },
 "region": [
  "global"
 ],
 "facets": {
  "family": "neurological",
  "setting": "day-case",
  "anaesthesia": "general"
 },
 "text": {
  "what": "An electronic device that bypasses the damaged inner ear and stimulates the hearing nerve directly. The US National Institute on Deafness and Other Communication Disorders describes four parts: a microphone, a speech processor, \"a transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses\", and \"an electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve\". The receiver-stimulator and the array are surgical and permanent. The microphone and processor are worn, replaceable, and priced separately. As of December 2019 the institute counts \"approximately 736,900 registered devices\" implanted worldwide.",
  "story": "The operation travels easily. The aftercare does not, and this is the clearest case in the directory of an operation whose price is the smaller half of the transaction.\n\nNothing about implantation itself resists being sold as a package: a couple of hours under general anaesthetic, a short stay, a wound that heals. What follows does resist. The device is switched on weeks after surgery, not in theatre, and is then programmed repeatedly — often, at first, and then for life. The institute puts the demand plainly: \"use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing\", with speech-language pathologists and audiologists involved throughout. A Finnish cost-effectiveness study published in 2025 says the same from the payer's side: an implant \"requires life-long aftercare including regular check-ups, software and sound processor upgrades and sometimes a device replacement\".\n\nThe processor is the trap inside the trap. Its warranty runs three years. Its modelled mean life before upgrade is 106 months — about nine years, on a range of 29 to 232 — sourced in that Finnish model to a manufacturer's own database. And when a model goes out of production the problem is not fashion: \"access to spare parts is reduced for obsolete sound processors that are no longer manufactured, reducing the ability to service and repair sound processors, leaving recipients without a functioning CI system and no functional hearing\". An implanted ear with a dead processor is a deaf ear.\n\nAustralia has measured what that costs. The CUSP study upgraded 340 processors in 304 adults aged 65 and over between May 2021 and April 2023, all of them with obsolete processors and no funding to replace them; its authors describe the position as \"an increasing public health challenge in Australia and worldwide\", and found the economic value of upgrading came \"from preventing device failures, rather than from access to newer technology features\".\n\n*Inference —* every one of those facts lands harder on a patient implanted in another country. Programming is done by an audiologist on the manufacturer's software with the patient's own map; a clinic at home that never implanted the device may not hold the map, may not stock the parts, and may not take the patient on.",
  "how": "General anaesthesia; the array is threaded into the cochlea and the receiver seated in a well drilled in the bone behind the ear. *Trade practice —* the operation runs a couple of hours and is commonly a day case or a single night, and the two ears are sometimes done in one sitting. Switch-on comes weeks later, once the wound has settled, and is followed by a run of mapping appointments — frequent in the first year, then periodic for life. Rehabilitation is the long part: the brain has to learn to read the signal. The published failure figures are for the internal device: a Finnish model uses a 2.8% probability of internal device failure, an Australian model 4.8% over thirty years, with reimplantation — another operation — costed at 39,519 Australian dollars.",
  "today": "The published prices that matter here are for the parts, not the operation. At the time of the Australian CUSP study the out-of-pocket cost of a replacement processor was 7,648 Australian dollars for a Nucleus 5, 8,114 for a Kanso 2 and 9,078 for a Nucleus 7, which the authors say \"limits CI users' ability to upgrade sound processors without public subsidy\". The Finnish model puts the whole lifetime cost of a unilateral implant, care included, at 43,905 euros. No hospital price list for implantation for a self-paying foreign patient was read for this record on 16 September 2026.",
  "notes": "This page describes a device and what maintaining it involves. It is not advice about whether to have one, or where."
 },
 "metrics": {
  "stay_days": null,
  "days_before_flying": null,
  "recovery_weeks": null,
  "note": "No published ward stay, flight interval or recovery span was read for this record on 16 September 2026, so all three print as gaps. The interval that governs this device is a different one: a three-year processor warranty, a modelled mean of 106 months before a processor is upgraded, and programming appointments for life.",
  "as_of": "2026-09-16",
  "source": "s:eur-arch-ci-finland",
  "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12605616/"
 },
 "prices": [
  {
   "procedure": "cochlear-implant",
   "country": "AU",
   "amount": 7648,
   "amount_high": 9078,
   "currency": "AUD",
   "as_of": "2022",
   "kind": "list",
   "includes": [
    "one replacement external sound processor"
   ],
   "excludes": [
    "the implant",
    "the operation",
    "programming appointments",
    "repairs outside the three-year warranty"
   ],
   "source": "s:pharmacoecon-ci-upgrade",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/",
   "note": "the range covers three models priced at the time of the CUSP study: Nucleus 5 at A$7,648, Kanso 2 at A$8,114 and Nucleus 7 at A$9,078. This is the accessory, bought perhaps three or four times in a recipient's life, and it is the line that decides whether an implant keeps working.",
   "tier": "cited",
   "usd": 5451.0,
   "usd_high": 6470.0,
   "rate_date": "Wed, 16 Sep 2026"
  },
  {
   "procedure": "cochlear-implant",
   "country": "AU",
   "amount": 39519,
   "currency": "AUD",
   "as_of": "2022",
   "kind": "estimate",
   "includes": [
    "reimplantation after internal device failure"
   ],
   "source": "s:pharmacoecon-ci-upgrade",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/",
   "note": "the cost used in an Australian microsimulation for replacing a failed internal device, alongside a 4.8% risk of internal failure over thirty years and three months with the device inactive.",
   "tier": "cited",
   "usd": 28165.0,
   "usd_high": null,
   "rate_date": "Wed, 16 Sep 2026"
  },
  {
   "procedure": "cochlear-implant",
   "country": "FI",
   "amount": 43905,
   "currency": "EUR",
   "as_of": "2025",
   "kind": "estimate",
   "includes": [
    "assessment",
    "the device",
    "surgery",
    "lifetime aftercare, check-ups, software and processor upgrades, and device replacement where modelled"
   ],
   "excludes": [
    "anything a health system does not pay for"
   ],
   "source": "s:eur-arch-ci-finland",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12605616/",
   "note": "the modelled lifetime cost of one unilateral implant to the Finnish health system, from a published cost-utility analysis. A modelled lifetime, not an invoice — but it is the only figure read for this record that counts the follow-up as part of the price.",
   "tier": "cited",
   "usd": 50657.0,
   "usd_high": null,
   "rate_date": "Wed, 16 Sep 2026"
  }
 ],
 "kin": [
  {
   "to": "follow-up-gap",
   "as": "The exact shape of this device's problem: an operation that crosses a border easily and a programming appointment that does not.",
   "rel": "risk"
  },
  {
   "to": "aftercare-at-home",
   "as": "Where the map, the spare parts and the audiologist have to be, for the rest of the patient's life.",
   "rel": "step"
  },
  {
   "to": "revision-at-home",
   "as": "Who reimplants a failed internal device, and on whose bill.",
   "rel": "risk"
  },
  {
   "to": "implant-excluded",
   "as": "The same trick in another trade: a price for the operation that is not a price for the hardware.",
   "rel": "risk"
  },
  {
   "to": "the-discharge-summary",
   "as": "The paper a patient carries home, which for this device has to include the implant model and the map.",
   "rel": "step"
  },
  {
   "to": "india",
   "as": "Runs implant programmes and a state subsidy scheme, and takes patients from neighbouring countries with none.",
   "rel": "destination"
  },
  {
   "to": "turkiye",
   "as": "Implants at scale under a licensing regime for foreign patients.",
   "rel": "destination"
  },
  {
   "to": "australia",
   "as": "Where the shortfall in replacement processors has been measured and published.",
   "rel": "place"
  },
  {
   "to": "insurance-exclusions",
   "as": "Where a payer funds the implant and declines the processor nine years later.",
   "rel": "rule"
  }
 ],
 "links": [
  {
   "label": "NIDCD — Cochlear Implants",
   "url": "https://www.nidcd.nih.gov/health/cochlear-implants"
  },
  {
   "label": "Cost effectiveness of upgrading cochlear implant sound processors in Australia",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/"
  }
 ],
 "sources": [
  "s:nidcd-cochlear",
  "s:pharmacoecon-ci-upgrade",
  "s:jcm-cusp-upgrade",
  "s:eur-arch-ci-finland"
 ],
 "provenance": {
  "default": {
   "tier": "cited"
  },
  "fields": {
   "text.story": {
    "tier": "cited",
    "source": "s:pharmacoecon-ci-upgrade",
    "note": "device, warranty and upgrade figures cited; the closing paragraph about an implant recipient in another country is marked Inference"
   },
   "text.how": {
    "tier": "cited",
    "source": "s:eur-arch-ci-finland",
    "note": "failure and reimplantation figures cited; the operating time and day-case pattern are marked Trade practice"
   },
   "prices": {
    "tier": "cited"
   },
   "etymology": {
    "tier": "tradition"
   }
  }
 },
 "x_commons_files": [
  "File:Cochlear implant.jpg",
  "File:Cochlear implant diagram.svg"
 ],
 "confidence": "high",
 "updated": "2026-09-16",
 "blurb": "An electronic device that bypasses the damaged inner ear and stimulates the hearing nerve directly.",
 "region_terms": [
  {
   "key": "global",
   "name": "Everywhere",
   "note": "use for a node that belongs to no one country — a standard, a word, a risk"
  }
 ],
 "kin_out": [
  {
   "to": "follow-up-gap",
   "type": "risk",
   "name": "The follow-up gap",
   "as": "The exact shape of this device's problem: an operation that crosses a border easily and a programming appointment that does not.",
   "rel": "risk"
  },
  {
   "to": "aftercare-at-home",
   "type": "pathway",
   "name": "Aftercare at home",
   "as": "Where the map, the spare parts and the audiologist have to be, for the rest of the patient's life.",
   "rel": "step"
  },
  {
   "to": "revision-at-home",
   "type": "risk",
   "name": "Revision at home",
   "as": "Who reimplants a failed internal device, and on whose bill.",
   "rel": "risk"
  },
  {
   "to": "implant-excluded",
   "type": "risk",
   "name": "The implant is excluded",
   "as": "The same trick in another trade: a price for the operation that is not a price for the hardware.",
   "rel": "risk"
  },
  {
   "to": "the-discharge-summary",
   "type": "pathway",
   "name": "The discharge summary",
   "as": "The paper a patient carries home, which for this device has to include the implant model and the map.",
   "rel": "step"
  },
  {
   "to": "india",
   "type": "destination",
   "name": "India",
   "as": "Runs implant programmes and a state subsidy scheme, and takes patients from neighbouring countries with none.",
   "rel": "destination"
  },
  {
   "to": "turkiye",
   "type": "destination",
   "name": "Türkiye",
   "as": "Implants at scale under a licensing regime for foreign patients.",
   "rel": "destination"
  },
  {
   "to": "australia",
   "type": "destination",
   "name": "Australia",
   "as": "Where the shortfall in replacement processors has been measured and published.",
   "rel": "place"
  },
  {
   "to": "insurance-exclusions",
   "type": "rule",
   "name": "Insurance exclusions for treatment abroad",
   "as": "Where a payer funds the implant and declines the processor nine years later.",
   "rel": "rule"
  }
 ],
 "source_list": [
  {
   "id": "s:nidcd-cochlear",
   "kind": "gov",
   "title": "Cochlear Implants",
   "publisher": "National Institute on Deafness and Other Communication Disorders, US National Institutes of Health; page updated 13 June 2024",
   "url": "https://www.nidcd.nih.gov/health/cochlear-implants",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:pharmacoecon-ci-upgrade",
   "kind": "paper",
   "title": "The Cost Effectiveness of Upgrading Cochlear Implant Sound Processors in Australia: A Novel Application of Individual-Level Microsimulation Models",
   "publisher": "PharmacoEconomics, 2026, doi:10.1007/s40273-026-01588-2",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13110226/",
   "accessed": "2026-09-16",
   "note": "carries the out-of-pocket sound processor prices current at the time of the CUSP study, in 2022 Australian dollars, and the modelled cost of reimplantation"
  },
  {
   "id": "s:jcm-cusp-upgrade",
   "kind": "paper",
   "title": "Evaluating the Clinical- and Cost-Effectiveness of Cochlear Implant Sound Processor Upgrades in Older Adults: Outcomes from a Large Australian Multicenter Study",
   "publisher": "Journal of Clinical Medicine 14(11):3765, 2025, doi:10.3390/jcm14113765",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12155704/",
   "accessed": "2026-09-16",
   "note": "the CUSP study; 340 sound processors upgraded in 304 adults between May 2021 and April 2023"
  },
  {
   "id": "s:eur-arch-ci-finland",
   "kind": "paper",
   "title": "The cost-effectiveness of unilateral cochlear implantation in the Finnish health care",
   "publisher": "European Archives of Oto-Rhino-Laryngology, 2025, doi:10.1007/s00405-025-09468-9",
   "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12605616/",
   "accessed": "2026-09-16",
   "note": "its model parameter table gives a mean time to sound processor upgrade sourced to a manufacturer's internal database"
  }
 ],
 "tiers": {
  "text.what": {
   "tier": "cited"
  },
  "text.story": {
   "tier": "cited",
   "source": "s:pharmacoecon-ci-upgrade",
   "note": "device, warranty and upgrade figures cited; the closing paragraph about an implant recipient in another country is marked Inference"
  },
  "text.how": {
   "tier": "cited",
   "source": "s:eur-arch-ci-finland",
   "note": "failure and reimplantation figures cited; the operating time and day-case pattern are marked Trade practice"
  },
  "text.today": {
   "tier": "cited"
  },
  "etymology": {
   "tier": "tradition"
  },
  "prices": {
   "tier": "cited"
  },
  "metrics": {
   "tier": "cited"
  }
 },
 "primary_image": null,
 "tag_facts": [],
 "recognition_facts": [],
 "acclaim": 0,
 "kin_in": [
  {
   "from": "implant-excluded",
   "type": "risk",
   "name": "The implant is excluded",
   "as": "Where the external processor is a separate purchase from the operation.",
   "rel": "procedure"
  }
 ]
}