Accessibility to cochlear implants in Belgium: State of the art on selection, reimbursement, habilitation, and outcomes in children and adults

Abstract

Belgium, and especially the northern region called Flanders, has been a center of expertise in cochlear implants and early hearing screening for many years. Some of their surgeons and engineers were pioneers in the development of cochlear implants and in 1998 Flanders was the first region in Europe to implement a universal hearing screening program for all neonates. The Belgian National Institute for Health and Disability Insurance has reimbursed cochlear implants in children and adults since 1994 and bilateral implantation in children under the age of 12 years since February 2010. These deaf children, screened and implanted early, achieve higher auditory, speech and language outcomes and increasing numbers are going to regular schools using fewer interpreters. In 2010, 93% of severe-to-profound deaf preschool children in Flanders had received cochlear implants and 25% had bilateral implants. Although on average twice as many adults as children are implanted a year in Belgium, we have less research data available from this adult population. Also very little is published about the growth curves and minimal rehabilitation requirements (intensity, duration etc.) after implantation for both children and adults. So, there still remain many challenges for the future.

How many patients will be eligible for cochlear implantation (CI) on audiological grounds, once the new 2019 NICE guidance takes effect? Evaluation of audiological data for the population of East Kent to estimate cochlear implantation eligibility based on NICE 2019 guidance (TA566) and NICE 2009 guidance (TA166)

“…Currently, 14,15 Our estimated uptake rate whilst higher than previous UK estimates still falls below the uptake rate of perhaps 10% in Belgium and Germany. 16,17 As can be seen from the data (see Table 2 and Figure 1)…”

Evaluation of pediatric cochlear implant care throughout Europe: Is European pediatric cochlear implant care performed according to guidelines?

“…Nevertheless, in Belgium, only partial NBHS is, or was initially, implemented (Soares Aurelio and Tochetto, 2010). Although NBHS was implanted early in the Belgian Flanders region, in the Walloon region NBHS was implemented only in 2006 (De Raeve andWouters, 2013;Vos et al, 2013). This NBHS implementation in the Walloon region could explain the steep decline in age at implantation between 2005 and 2008.…”

Langzeitergebnisse eines Screeningverfahrens für erwachsene Cochlea-Implantat-Kandidaten

“…Das Verfahren basiert auf nur 2 audiometrischen Größen: Der bei 4 Frequenzen (0,5; 1; 2; 4 kHz) gemittelte Hörverlust (4 frequency puretone average, 4FPTA) und das maximale Einsilberverstehen im Freibur-gerTest(mEV)werdenfüreineKlassifikationgenutzt.Anhandbeider Größen wird abgeschätzt, ob der Patient mit Hörgerät ein Sprachverstehen von 30 % nicht erreicht. Das Kriterium von 30 %-igem Sprachverstehen mit Hörgeräten bei 65 dB SPL , EV 65 (HG), isteinanerkannterIndikatorfüreininsuffizientesAlltagshören [12]. Hinter der Auswahl der beiden Größen, 4FPTA und mEV, steht die Beobachtung, dass bei höhergradigen Schwerhörigkeiten das maximaleEinsilberverstehenhäufignichtmitdemHörgerätumgesetzt werden kann [11,13].…”