Will cochlear implants be obsolete when stem cells comes?

[deafdude1]

I had this talk with my friend and he says the CI market will just be smaller. He says stem cells may fail to give some profoundly deaf people enough improvement that they would still be CI candidates. However insurance won't pay for CI till you first get stem cells and try the best HAs. He also says not to expect a full restoration of hearing because of greed and profit.

The audiologists and hearing aid companies will do something about this, they don't want to go out of business. So they may limit the power of stem cells to the point that a 50db, maybe 40db will be the best possible hearing you could hope to eventually achieve. Youd still buy HAs but at least this small of a hearing loss could be aided down to baseline 0db unlike profound losses which rarely get aided to better than 30db and with reduced quality.

Audiologists may push you towards CI so they can get a fat commission. When stem cells get FDA approval(he says 10 years for that, 5 years in other countries) they will push you towards stem cells. Im guessing insurance won't pay for stem cells but instead will start paying for HAs for those with severe-profound losses. There will be class A HAs which are powerful medical devices with gains above 40db, SPL above 110db and class B HAs with gains up to 40db, SPL up to 110db that can be sold cheaply over the counter like reading glasses. Your loss must be within the fitting range for insurance to pay for class A, else you buy your own class B. Class B will be great for mild to moderate losses.

Of course there will be alot of other limitations on class B HAs. For those who need features and ability to program, they will still have to buy it from an audiologist and he will make money. Youd also need custom molds if you don't find the dome "molds" comfortable enough. It's the same for those who need custom prescription glasses beyond the one size fits all reading glasses. I do think they should offer low minus glasses over the counter just like they do with low plus.

It's possible you may be able to get financing for the $25,000-$50,000 cost(depending on your degree of loss and audiogram) of stem cells for both ears via a low interest medical loan with 20% down. There may be a guarantee of 10db PTA(pure tone average) improvement over your current hearing for qualifying candidates. Such candidates may have 80db or worse PTA loss. Those with less loss don't get the guarantee or may even be rejected alltogether. Just like many lasik centers guarantee 20/40 or you can repeat the laser procedure free! If this still doesn't get you 20/40 then you get refund of the $5000 cost. Thus those who get less than 10db PTA average of improvement can repeat the stem cell procedure free and if this still doesn't help enough, get your refund.

Thus there would be no worries. Youd be able to choose to stay deaf, choose stem cells or choose a CI if your stem cell choice fails to give 10db or more improvement. Those that choose to stay deaf can get powerful HAs from insurance and enjoy hearing environmental sounds and reading lips. Those that choose stem cells and it doesn't help much can get CI from insurance as a last resort. They pay nothing for stem cells nor CI and enjoy some access to sounds/speech. For those who get significent benefit from stem cells, they can pay off the medical loan over a decade and should be happy because they hear way better than CI plus get some ability to hear unaided as a HOH individual.

Everyone must first try stem cells as CI candidacy requirements will become much more strict and be seen as a last resort. Those with no residual hearing(125db HL arbitrary value) could have a guarantee of getting down to 100db PTA, else you get refunded for stem cells and get free CI from insurance since CI is very likley better than 100db loss. Get down to better than 100db PTA, you meet the guarantee and no refunds and insurance won't pay your CI, youll have to pay for CI yourself or wait for stem cell technology to mature and pay again to get more stem cells.

Those with different amounts of losses can have different guarantees on how much improvement is the minimum stem cells would give you. In my case, they may guarantee a 15-20db improvement or that ill get to at least 90db PTA. I could see my loss at 250Hz improve to 50db which would be really great! At 500Hz it could become 65db, at 1000Hz it could improve to 85db and at 2000Hz it may be 95db. My new PTA would be 82db which would be enough to meet the guarantee. Id have some ability to hear unaided for the first time in my life! as well as hearing the best ive ever heard before in my life with powerful HAs. I can always get more stem cells 5 years later(yes, id pay again) for even more improvements, perhaps down to a PTA of 60db!

What I say is an estimate of what stem cells could deliver and what one of my friends believes will be the case. You can bet I plan to try stem cells first(will apply for clinical trials or travel) as I consider CI a last resort and its very likley stem cells can give me at least 20db improvement. No one knows if CI will be obsolete or if just less people will get CI as candidacy requirements will get strict like they were before 2005. Vote in the poll and share your thoughts. The above is the thoughts me and my friend were discussing about.

 

[ref74]

I think it is just too early for any forecast.
The future for CI and HA will depend on the success of the stem cells therapy, but we will probably need to wait many years to see this technique mature enough and really be able to come to a well argumented judgements. Hopefully, stem cells will be able to cure any kind of hearing loss. If this will really happen and if the costs, risks, indications will be affordable for any kind of patient, CI and HA market will become a niche, or disappear completely. That's pretty normal when a new technology overcome completely the old established technologies. Anyway, this will requires some decades to happen.

 

[Phi4Sius]

We've only just begun to scratch the surface of stem cells. Stem cells will be to the ear what Lasik is for the eyes, but without the detractions of Lasik. As more development on stem cell treatments occurs, we're going to start seeing clinics being able to cure profound losses. My predictions on treatments?

Phase I ($5,000 per ear?):

Diagnosis of hearing loss
First phase of frequencies (250 Hz - 1500 Hz)
High concentrations of stem cells to deliver significant gains in the lower frequencies. Expectant gains of 50 dB at the very least for profound losses in these frequencies.

Phase II ($7,500 per ear?):

Second phase of frequencies (1500 Hz - 3000 Hz)
Significantly higher concentrations of stem cells to deliver significant gains in the mid frequencies. Expectant gains of at least 40 dB will be common.

Phase III ($8,500 per ear due to the last phase of frequencies necessary to achieve perfect hearing?):

Third phase of frequencies (3000 Hz and above)
The highest concentrations of stem cells to restore high frequency hearing. Imagine the strings on the piano. The higher frequency notes require much much tighter, "harder", higher density strings if you will. If the high frequency hair cells in the human ear match the strength of those on the piano, then much higher concentrations of stem cells (not less) as therapy moves forward will be required to restore higher frequency hearing.

This is my prediction of therapies as companies become more and more knowledgeable about stem cells and their effectiveness at regeneration of hearing at all frequencies.

 

[Bottesini]

I voted that more will choose stem cells. It is a natural and safe way.

 

[SkullChick]

no i'd pick ci over stem cell anytime anyday, its proved effective way to restore hearing in profoundly deaf people and its very safe with little risk and minimal surgery, when stem cell, many things could go wrong like what if only 500 nerves grew out of 100,000 and get crappy hearing, it can also just die again you have it in your gene to be deaf, just putting new nerves in it'll just die again so thats waste of thousands dollars when CI guaranteed to provide you hearing 97% of time (evironment to superhearing lol)

 

[Phi4Sius]

SkullChick- In thousands of cases of stem cell treatments (for other diseases and medical conditions) overseas, I have not heard of one case developing significant complications as a result of treatment.

We're not talking about re-building the nerve anyways. We're talking about restoring the hair cells attached to the nerve - the tiny hairs within the organ of corti that provides the ability for regular people to hear. Assuming that nothing happened to the nerve at all (a botched surgery for example) and the nerve itself hasn't been touched or harmed as a result of the hearing loss, the hairs will re-grow again with the stem cells and all will be well.

And, such stem cell treatments can be accomplished by a simple injection (assuming an external source of concentrated stem cells are used) - far far FAR less invasive than a CI surgery and requiring even less downtime for treatment once appropriate concentrations are determined.

As soon as they prove it works over here, CI and hearing aids will be dead or delegated only to a very small niche market that will like them. Guaranteed.

Stem cells will spread like computers have, and everyone with a moderate hearing loss and below will want this treatment. No one will want to wear hearing aids or other device on their ears when a natural restoration of sensorineural hearing loss is available. The biomedical revolution is here - and I believe it's time to embrace it.

Also, I'm sure they will find a way for current CI implantees to be able to obtain stem cells as well. Assuming the CI hasn't damaged the cochlea too much and stem cells can be used in such a way to heal the cochlea from damage from the implant, stem cells will be a reality for everyone.

 

[kokonut]

Certainly it'll become obsolete. It's just a matter of time as biotechnology improves to the point where "mechanical" assistence would not be needed in favor of a more natural and safer application.

If CI to be made obsolete someday because of biomedical advancements that can cure hearing loss may mean an eventual obsoleteness for one particular culture, too.

 

[Watermelon]

A lot of it depends on the medical effectiveness that stem cell treatment actually has. If it has to rely upon residual hearing for effectiveness, then it's not really much of an option for those who have none. Hence, CI would still be around. If it could regrow the hair regardless of residual hearing, then that's an even smaller market for CI. But, there may be some people for whom it would not work. For them, they still have the CI. For some who have consistent progressive loss, stem cells wouldn't necessarily be successful in the long term since they'd lose it again. Even if stem cells work effectively on a wide scale, there'd still be a market for CI, albeit smaller. In my humble opinion, stem cells, or CI's for that matter, are not a silver bullet for realigning hearing loss to normal hearing levels. Stem cells may be a stepping stone, but there's still a long way to go, yet.

 

[faire_jour]

I don't believe that stem cells will ever be a real option. That wasn't a choice, so I didn't vote.

 

[deafdude1]

I don't believe that stem cells will ever be a real option. That wasn't a choice, so I didn't vote.

Please elaborate your response and what you think is the extent of improvement stem cells can achieve. I am a huge fan of stem cells and so are my parents and almost all hearing people.

 

[faire_jour]

Please elaborate your response and what you think is the extent of improvement stem cells can achieve. I am a huge fan of stem cells and so are my parents and almost all hearing people.

I do not believe that stem cells will ever be used to treat hearing loss.

Clear enough?

 

[deafdyke]

Deafdude............I agree with faire_jour. Stem cells as a treatment for hearing loss is still very much up in the air. It could prove helpful.....but then again it could prove as bogus as the science of pherenology.

 

[Phi4Sius]

Just as in the CI debate, the stem cell debate welcomes all opinions. However, the fact of the matter is that those who don't believe in stem cells are forgetting one thing: stem cell CD133+ HAS been proven conclusively and scientifically to regenerate hearing hair cells in mammals. We're seeing more and more cases of people being treated with this stem cell that have shown improvement in their hearing in other countries.

It's only a matter of time before the discovery is built upon and is developed into an effective treatment for hearing loss in the United States. Stem cells have already treated many full fledged diseases like alzheimer's, stroke, even blindness. This is why so many people are fleeing to China in order to get these treatments, because the Bush administration banned them here.

It's not science fiction at this point, nor is it a matter of belief. It's only a matter of when.

If it wasn't already effective in other countries, an FDA-registered facility would not be starting human trials in the United States using stem cells to treat hearing loss:

CBR Center for Regenerative Medicine - Hearing Loss - Cord Blood Stem Cells from Cord Blood Registry

I realize that there are those who don't want to have made a wrong choice in their decisions to get a Cochlear Implant- that's certainly understandable and the stem cell debate welcomes all opinions especially when considering this fact. However, the fact remains that opinions cannot counter real, scientific evidence. It's like being on the brink of proving the world is round rather than flat - the steadfast flat earthers will not be bringing their ships with us earth-is-round pioneers to sail around the world.

Sorry for being so blunt, but I'm placing my bets on these new stem cell treatments that are being developed.

To paraphrase a particular individual whose colleague was treated with stem cells for his hearing loss and has shown significant improvement in his hearing: GO STEM CELLS GO!!!!

 

[faire_jour]

In mammals, not in humans.

And I will believe it when I see it.

When stem cell treatments have been shown to be safe and effective and FDA approved for 20 years, THEN I will allow them to treat my child with that. CI's have been down that road. How can it be a bad decision to do something that works rather than cross your fingers and hope that something better comes along?

 

[john57]

It is unlikely that Stem cells will have much improvement with people that have small cochlea's to begin with, however I have great success with my CI implant with my small cochea's. Some people do not have the full 2 /12 turns in their cochlea's but still can have some success with a CI implant. You must have a working basilar membrane that will actually tell which hair cells to move otherwise a CI implant may be a better option. There also more cases of children contracting meningitis which in turn caused the cochlea to be ossified, could stem cells work in this case? The stem cells may have a better chance with people that had normal hearing but lose it latter in life. What about babies that are born with hearing loss? What do you think their chances are with stem cells? Since I had a flat hearing loss which strongly indicated that I did not have much if any outer hair cells. Can the stem cell therapy tell the difference between inner and outer hair cells? It seems to me that drilling still needs to take place and some form of injection with a hole to place the Stem Cell solution into the cochlea. Is this a small improvement of safety over CI?
It has been show that birds can regenerate their hair cells but not as uniform as before. Sounds to me that there is a good chance of getting sounds sensitivity back but the quality of sound is unknown. If seems that there is many " ifs"and questions but maybe stem cell may work.
I wonder if medical science actually cure" a disability yet?

 

[Phi4Sius]

In mammals, not in humans.

And I will believe it when I see it.

When stem cell treatments have been shown to be safe and effective and FDA approved for 20 years, THEN I will allow them to treat my child with that. CI's have been down that road. How can it be a bad decision to do something that works rather than cross your fingers and hope that something better comes along?

fair_jour- Humans ARE mammals by scientific classification. Anyway, regardless of classification, it's been proven in both animals and humans. Granted not yet on a large scale but it's certainly only a matter of time before treatments are available for the masses.

Also, we're not calling a CI a bad decision - I never said that and never implied it.

The reason I chose not to get a CI was based off of those audio samples and my research - why would I choose a device that has such poor quality of sound that it would detract from my right ear's hearing? That would be a bad decision. Also, it's been shown that even when implanted, CIs don't always help people with severe-profound hearing loss. They can be better, they can be worse. People are hearing nothing but pulses after being implanted with a CI that don't get better. Do I want that? No. I don't want to take that risk with my left ear when I have good hearing in my right ear (natural residual hearing is always going to be better than an implant) and I don't want my left ear's cochlea to be scarred by the Cochlear Implant (due to long exposure to electrical impulses), which could render using stem cells useless.

Also, a CI may certainly help- but that doesn't mean it's better than normal hearing. No device is - even hearing aids aren't as good as normal hearing, but you're using your normal residual hearing at amplified levels which can be programmed to be better than a CI.

Once a CI has been implanted - there is no going back and a distinct possibility of not regaining my natural hearing with stem cells. With something so permanent it was my decision not to go with that choice in order to regain my natural hearing with stem cells when they're a viable treatment in the near future.

Is that a bad decision? No. It certainly isn't. And neither was getting the CI in your case. What's best is what will help - even if it isn't natural hearing.

I'm still a big fan of stem cells and their effectiveness so far though.

 

[faire_jour]

Just because something works in a rat does NOT mean it will work in humans. (All humans are mammals, but not all mammals are humans)

Those audio samples are crap. I know kids with CI's who can tell when a cartoon character is being voiced by a different person. Nearly all people who have CI's who previously had normal hearing say that within 6 months it is as if they had never lost their hearing at all. The CI sounds exactly like their normal hearing did.

And you are wrong. The research shows that at about 75 db loss, CI give better hearing than amplified residual hearing. You may not get it programmed to 0 db to hear an ant fart, but your speech understand will go up.

Clearly you have been listening to deafdude way too much. He is blantantly anti-CI, (though I am obviously pro-CI) because he is afraid. He is afraid to leave his clinging obsession with hearing aids to find out if he could hear better with a CI. He thinks that he is doing fine, and he has no idea what he is missing. He never will. I will lay down money that he will go to the grave with his hearing aids and talking about how "if only". I would offer to pay for his sugery, out of pocket, if he gets a CI, and then hears worse than he did with his aids. It just won't happen.

And yes, in your last post you did say "I realize that there are those who don't want to have made a wrong choice in their decisions to get a Cochlear Implant- that's certainly understandable " That is more than implying that it is the wrong decision. It is flat out saying it.

 

[Phi4Sius]

Just because something works in a rat does NOT mean it will work in humans. (All humans are mammals, but not all mammals are humans)

You are wholeheartedly biased towards Cochlear Implantation aren't you? You won't even consider that something else works and is a superior solution? Why defend CI when there are obvious drawbacks? The data may certainly show significantly better understanding and tone audiometry. Big deal. That doesn't always translate to better quality of life and understanding overall. You're totally defending the CI as THE CURE when it clearly is not. It's a tool- and it all depends on how it is used and how it is implanted whether or not someone hears better with it. You do realize that the hybrid CI has already fallen flat right?

Those audio samples are crap. I know kids with CI's who can tell when a cartoon character is being voiced by a different person. Nearly all people who have CI's who previously had normal hearing say that within 6 months it is as if they had never lost their hearing at all. The CI sounds exactly like their normal hearing did.

Okay. So they can hear characters voiced by a different person. Big deal. And sure, they'll say within six months that the CI sounds as if they never lost their hearing at all BECAUSE they have been profoundly deaf for awhile. The brain gets used to it and they develop habits to get around deficiencies. Why do you think FDA criteria has such strict requirements? Because people with profound hearing losses for awhile won't be able to tell the difference between normal hearing AND CI implantation!!! There's a reason for that.

And you are wrong. The research shows that at about 75 db loss, CI give better hearing than amplified residual hearing. You may not get it programmed to 0 db to hear an ant fart, but your speech understand will go up.

At 75 dB loss, SURE! Powerful hearing aids can still give you higher thresholds than CIs. There are hearing aids (the Phonak Naida, for example, that have serious gain AND gives output amplification levels of above 120 dB!!!). This is not conjecture, but based on the data within the data files on the Phonak web site.

Again, why do you think the FDA requirements for Cochlear Implants are so strict and why they drag out the process? Because they don't want hearing people hearing the "difference" between normal hearing and CI. They hear speech yes, but what about all the other sounds that are so important to enjoying hearing? I certainly enjoy those well with my analog HA, which I will gladly keep enjoying until the stem cell therapy arrives, not within 20 years, but within the next five (5) years once they find out this stuff works. FDA approval will be swift, quick, and destroy CI in the process. Even if the FDA drags their feet, people will just join clinical trials or get stem cells in other countries who are more ahead of the United States.

Also, the CI center that implants ANYONE with more speech and hearing than FDA requires IS doing it experimentally. They're going against the grain and hoping for an improvement and that it will work out - the SAME thing you are accusing us of doing when it comes to waiting for stem cells.

BTW...for the record. I have a 70 dB loss with an analog HA in that ear. Do I understand phones? YES! Do I understand without reading lips? ALL THE TIME! Do I do great with an analog HA? YES! Do I get high scores in all of my classes in school regardless? YES!! Did I get rejected by insurance for CI because I hear too much with HAs?! YES! And of course, my tests would have shown AGAIN that I hear too much with an HA and I would have been denied. Why do you think they deny implantation when someone has so much residual hearing?

Clearly you have been listening to deafdude way too much. He is blantantly anti-CI, (though I am obviously pro-CI) because he is afraid. He is afraid to leave his clinging obsession with hearing aids to find out if he could hear better with a CI. He thinks that he is doing fine, and he has no idea what he is missing. He never will. I will lay down money that he will go to the grave with his hearing aids and talking about how "if only". I would offer to pay for his sugery, out of pocket, if he gets a CI, and then hears worse than he did with his aids. It just won't happen.

He is not anti-CI. He is pro real world approach in preserving residual hearing because NOTHING can REPLACE residual hearing once it is gone.

And I highly doubt that. Both of us will be happy like pigs in you-know-what once stem cells arrive. Stem cells are here and they ARE the future of restoring hearing loss.

For me, I am not anti-CI for those that need it. I'm anti-CI when an approach is being developed that will restore residual hearing. I'm anti-CI when people with too much residual hearing get an implant that will destroy their hearing and they will NEVER be able to get it back. I'm anti-CI because of the detrimental physical effects that it has on the cochlea that will not allow me to obtain stem cells. Will I wait? You can bet all the money you have in the bank that I will. And I won't be disappointed. It's better than having a magnet attached to my head for life.

And yes, in your last post you did say "I realize that there are those who don't want to have made a wrong choice in their decisions to get a Cochlear Implant- that's certainly understandable " That is more than implying that it is the wrong decision. It is flat out saying it.

No. There is no need to put words in my mouth. Flat out saying it would be "There are those who will not support stem cells because they made a wrong decision with getting the Cochlear Implant."

People have the right to choose to stick with Hearing Aids, get Cochlear Implants, or wait a few years for stem cells. For me, my friends, and family, they ALL support my decision in waiting for stem cell research to be completed. It's a personal decision, and one that I'm certainly sticking with for the future.

Human trials for stem cells to restore sensorineural hearing loss have begun on human babies under eighteen months that have had meningitis and viral infections w/high fever that destroyed their hearing. They wouldn't be experimenting on BABIES unless stem cells have already been proven to be SAFE and EFFECTIVE and they had already been proven in other countries already.

 

[ecp]

From a scientist who did research on hearing restoration

I have to say that the "stem cell" solution is very, very far in the future.
The major problem is that you can coax a stem cell to become any type of cell and it will. And it will make more cells. But it won't stop. And which cells should we replace?
Most people with profound hearing loss have badly damaged inner and outer hair cells. In addition, many of the support cells become atrophied.

I really think that the best solution is to let people make their own decisions and respect the decisions of others.

 

[Phi4Sius]

ecp- It will stop when the particular stem cell concentration injections cease. What's the date of that article? Source?

However, ecp, I certainly agree: "the best solution is to let people make their own decisions and respect the decisions of others."

I'm just defending my own position is all.