Health post: Cochlear implants

Back in Mumbai, I visited Cochlear Limited, the biggest producer of cochlear implants in the world. Cochlear implants are small medical devices for the deaf or severely hard of hearing, and they replace/bypass the damaged cochlea (the inner ear). Two-thirds of the cochlear implants in the world are made by Cochlear. Unlike a regular hearing aid, cochlear implants include a surgically inserted device, which requires a single surgery as well as an external piece that sits over the skin on the skull and contains a microphone and sound processor. The microphone picks up the sounds in the environment, the sound processor processes them, and then the device transmits the information to the implant. The external and internal parts connect via electromagnetic induction (the magnet is strong enough to hold through skin).

My contact at Cochlear, who did not want to be named, told me that while of course the implant itself is hidden, there’s a social stigma against the external part of the hearing aid. In the United States, Europe, and Australia, the mindset he’s observed is that “a hearing person is a normal person” – but not in India. Also, in comparison to the other health issues, he said that cochlear implants are the lowest priority of health here.

My contact said that the stigma here partially results from the fact that Indians are always focused on what others are doing. (I have definitely noticed this stereotype! I don’t get stares just because I’m a white woman; everyone seems to stare at each other no matter what.) So if you have a hearing aid or some other visual oddity, it could prompt your friends, relatives, and coworkers to point it out and ask questions. “What is that? Are you alright? How bad is your hearing?” and so on. Best to avoid it altogether, in that case. Of course, this is all per the stereotype and a large generalization, though it differs from the generalization about the United States that it’s considered rude to stare. I do think it’s true that most people might look and then glance away quickly, adopting a studied ignorance of the device (which could also perpetuate a stigma, but that’s a different discussion).

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On the left, you can see an older model of the cochlear external piece, which has 3 separate parts to the microphone, processor, and transmitter. It comes in neutral colors but there is an array of caps in bright colors and prints to modify the over-the-ear part. (Far to the right is the newer Kanso 3-in-one device).

At Cochlear, the internal implant is the same size for everyone, while the external processor is a different size depending on the model. In response to the consumer feedback research done by Cochlear’s R&D team, they’ve developed different color caps for the processor in case people want to decorate it – they’re trying to make it into a cool gadget like any other wearable (such as how Fitbit sells wristbands in all colors). But they have had trouble selling these caps in India, as they’ve observed that no one wants to advertise that they have a hearing issue. Instead, most people go without any aid and try to manage without telling anyone, as I mentioned. Cochlear is always working to avoid this stigma, so they developed Kanso, a subtler hearing aid, in response to stigma in general, in India and around the world. Kanso, which means “simple” in Japanese according to Google Translate, has no wires and no parts that sit on the ear (unlike Cochlear’s previous models), hiding instead on the back of the head in neutral colors to match hair. It was launched 2 months ago, so it’s hard to tell how successful it’s been so far.

I asked about the factors that would influence someone to accept or reject a cochlear implant device (ie, my “big question”). One of the main factors was age; many of the cochlear implants are bought by parents for their young children. Older people, however, will prefer to buy a $1000-2000 hearing aid over a $12,000 cochlear implant, even if the latter is the only device that will really give them hearing. After a certain age, they decide that it’s not worth it to spend that much money on hearing (money that could go to their children or grandchildren, for example), or they’re used to living without hearing, or they’ve really internalized the stigma.

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These are models of the internal part: the cochlear implant itself. This gets surgically inserted and never needs to be replaced. (If you look really closely, you can see a spiral shape at the end of some of the wires, and that’s what fits into the snail-shaped cochlear.

In addition to age and general stigma, Cochlear has noticed other barriers to acceptance of cochlear implants in India. One is a fear of surgery. I have heard this now from multiple people here in India, both project contacts and friends; most people would prefer to find a solution that does not involve anything invasive or surgical. Another barrier Cochlear mentioned is the desire to try traditional healing methods instead, such as working with babas and godfathers, which is somewhat common in the rural areas. Cochlear is especially concerned with tackling these barriers when it comes to children, who need auditory input before age 3 if they are to develop language skills properly.

I thought it was interesting that Cochlear’s R&D happens in Australia and the US, which means that when it comes to creating new products, most of their feedback comes from wealthy countries. This came up when I asked if Cochlear India was developing anything specifically for India that it wasn’t creating for its other markets. Though Cochlear sells all its products in all markets, they do try to erase the stigma in India with awareness campaigns. One way they advertise the need for cochlear implants is via the Cochlear India Facebook page. They also try to encourage people with a celebrity “hearing ambassador,” Brett Lee, a well-known cricket star in India who promotes Cochlear’s implants (http://www.cochlear.com/wps/wcm/connect/au/home/connect/cochlear-hearing-ambassador).

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The new Kanso device, which comes in neutral colors to hide under the hair. It sits back on the head, magnetically connecting to the implant.

As a global company, Cochlear has offices in many countries, including Sweden, India, Singapore, and Japan. That’s four of my six Watson countries! (If I haven’t mentioned it yet, I decided a couple months ago to add Singapore as a Watson country, and I’ll spend two weeks there between India and Japan). Anyway, I wish I had known about Cochlear earlier so that I could have met their team in Sweden. Still, it will be good to meet them in Singapore and Japan. It’s quite hard to compare and contrast the countries I visit – even though I’m obviously doing the same project in each, they are all so different. I think it will provide a good point of comparison to see the same company in 3 of the different countries.

I’m particularly looking forward to meeting with Cochlear in Japan. My contact was telling me that Japan is a difficult market for Cochlear because the deaf culture is so strong there. That is, there is so much respect for the deaf and pride among that community that it is almost insulting to suggest that deafness is a disability that should be corrected. So Cochlear is finding it hard to break into that culture and sell cochlear implants. India is a difficult market too, but for completely the opposite reason! (Of course, this is a sweeping generalization that I can’t back with numbers, but it’s an interesting idea that I’ll look out for when I arrive in Japan.)

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I was pretty impressed by Cochlear’s display packaging!

Lastly, a fun note for the engineers: I asked about the digital signal processing code on Cochlear’s sound processor. I learned about Cochlear’s SmartSound iQ sound processing system, which is designed to dynamically identify the type of sound in the surrounding environment (conversation, wind, music, etc.) before processing. The algorithms on the chip include a background noise reduction algorithm and a new wind noise reduction algorithm as well. For more details, check out http://pronews.cochlearamericas.com/cochlear-tech-talk-smartsound-iq/.

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