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The provision of cochlear implant services worldwide
The benefits of the multiple–channel cochlear implant have now been established in a series of studies. However, there are still many patients in need of the procedure who are not receiving help. In many cases these adults and parents of deaf children are unaware of the benefits of the device. There is therefore, a great need to provide up to date information through a number of channels. These should be through the medical/scientific community, and in particular professional associations in otolaryngology, audiology, speech pathology and education of the deaf. It would be helpful too if there was an official association concerned with cochlear implantation. As the procedure, one might say, has come of age, it is now timely to think of perhaps even a journal where publications of significance can be dispersed.

There is a great need that cochlear implants should now become more available to people in countries which have limited resources and manpower. Studies have shown cost benefits, and cost utility for the implant compared to other procedures, such as kidney transplants. To help deaf people in countries with limited resources there is also a need to involve international organizations to provide finance and other support. One of the greatest needs is to have rehabilitation and education support. International agencies could facilitate training for these professionals. Furthermore, as cochlear implants become more sophisticated, the speech processing improvements may become less evident, and the devices distinguished by additional facilities and greater convenience. Industry might therefore be in a position to provide standard devices at lower cost to these countries as well.

Another issue of concern is the need to standardize the total management of patients on a world wide basis. There are cases of surgery being undertaken in a haphazard fashion without due regard to the need to have a team approach to the patient particularly the provision of audiological, educational and speech services. Cochlear implantation is a procedure requiring expertise in a number of ways. Firstly, if cochlear implantation is a formal section of learned societies these can make representations to governmental health departments. A high standard in the field can also be achieved through the publication of cochlear implant journals, presentations at general Otolaryngological and other scientific meetings. There is also a need to develop an international body to analyze the performance of various commercial devices and provide the information publicly. Today there is a demand for evidence–based medicine and an independent body to provide a review of clinical trials. Cochrane Collaboration is an association involved in providing data on randomized trials for other procedures, and a similar association could be established to review cochlear implant findings. Maintaining clinic standards would also be facilitated by an industrial code of practice.

Although multiple–channel cochlear implantation is now an established clinical procedure it is important for the discipline that the future continues to be undertaken in accord with the Helsinki Declaration on Biomedical Research and in accordance with the Convention on the Rights of the Child, adopted by the General Assembly of the United Nations. Finally, the conflict with the signing deaf community over cochlear implants for children needs to be further addressed by the provision of up to date information. The rights of parents and the child for hearing and a good education are supported by the Convention on the Rights of the Child, adopted by the General Assembly of the United Nations 20 November 1989.