demand and capacity of cochlear implantations ruud van hardeveld
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DEMAND and CAPACITY OF COCHLEAR IMPLANTATIONS
RUUD van HARDEVELD
Content
1. European situation
2. Intermediate conclusions
3. Study on demand and necessary capacity
4. Conclusions
Total implantations up to 2008
0
2000
4000
6000
8000
10000
12000adults
children
All-users
CI-wearers per million inhabitants ultimo 2007
0
20
40
60
80
100
120
140
160
180
200
N(total)
Adults
Children
Implantation Capacity per Million in 2007
0
5
10
15
20
25
30
Bilaterally implanted Children
• Spain 228
• Sweden 218
• Italy 126
• Netherlands 67
• Belgium 42
• Turkey 4
• Luxembourg 4
CUMULATIVE NUMBER CI's per MILLION INHABITANTSNetherlands
0
20
40
60
80
100
120
140
160
2005 2006 2007
KIDS
ADULTS
TOTAL
NUMBER of CI's per yearNetherlands
0
50
100
150
200
250
300
350
400
450
2005 2006 2007
KIDS CI's
ADULTS CI's
TOTAL NUMBER
CI's per million inhabitantsNetherlands
0
5
10
15
20
25
30
2005 2006 2007
KIDS
ADULTS
TOTAL CI'S
Conclusions on state of art
1. Number of implantations/million inhabitants varies greatly
2. Rich countries (Ch, S) show a cumulative number of 180 implantations whereas less strong economies show about 40
3. The maximum implantation capacity is presently in between 20 and 25 per million
4. The less strong economies spent their short money on children
5. Bilateral implantation is still exceptional
AIM OF THE STUDY
• DETERMINE THE NUMBER OF POTENTIAL CI – CANDIDATES( THE EXISTING RESERVOIR)
• DETERMINE THE YEARLY FLUX into RESERVOIR- OF HOH- OF SUDDENLY DEAFENED ADULTS/ CHILDREN- OF NEONATES ( BORN DEAF OR PROFOUNDLY DEAF)
• COMPARE CAPACITY with POSSIBLE DEMAND NECESSARY VERSUS AVAILABLE,
RESERVOIR
BORN DEAF
CI-DEMANDPASSING TRESHOLD
DEAFENED ADULTS / CHILDREN
FLOW DIAGRAM
RESERVOIR
??????
BORN DEAF 200-240
TO CI400
PASSING TRESHOLD ?????
60-80
DEAFENED ADULTS / CHILDREN 200
70 - 100
FLOW DIAGRAM
THRESHOLD FOR CI
• HEARING LOSS > 90 dB on BETTER EAR
• SPEECH INTELLIGIBITY score < 30 - 40 %
• Additional criteria in personal performance sphere
CHALLENGING QUESTIONS:
How to estimate the number of
- HOH passing THRESHOLD ?
- Content of the RESERVOIR ?
COMBINE
- DATA on PREVALENCE of HOHA.DAVIS, Hearing in Adults,
London, 1995assuming:Data unchanged todayValid in Industrialized EU-countries
- DEMOGRAFIC DATA of CBS
Cumulative POPULATION ( MILLIONS )
AGE 1994 2004 2010
< 20 3,751 3,987 4,009
< 40 8,762 8,535 8,83
< 65 13,333 14,006 14,180
< 80 14,877 15,699 16,05
< 100 15,341 16,257 16,667
40-100 6,58 7,72 7,84
Prevalence in age group 18-80 years
-1,0
-0,5
0,0
0,5
1,0
1,5
2,0
2,5
0 10 20 30 40 50 60 70 80 90 100
Hearing Loss > X dB
log
arit
hm
(p
reva
len
ce %
)
SLOPE of PREVALENCE (P) versus HEARING LOSS in dB
• Log P(x) = 2 – 0,0278 x x = dB HL• P (x) = 100*10(exp -0,0278x)• P ( x + 10 ) = 0, 527 . P ( x )
• This formula says : The prevalence of HL at a certain level
decreases by a factor 1 / 0,527 = 1,9 if the HL increases 10 dB
-1,5
-1,0
-0,5
0,0
0,5
1,0
1,5
2,0
2,5
0 10 20 30 40 50 60 70 80 90 100
HL > x dB
Lo
ga
rith
m o
f p
rev
ale
nc
e %
age group 18 - 30
age group 31 - 40
age group 41 - 50
age group 51 - 60
age group 61 - 70
age group 71 - 80
overall
PREVALENCE per AGE GROUP
-1,5
-1,0
-0,5
0,0
0,5
1,0
1,5
2,0
2,5
0 10 20 30 40 50 60 70 80 90 100
HL > x dB
Loga
rithm
of p
reva
lenc
e %
age group 18 - 30
age group 31 - 40
age group 41 - 50
age group 51 - 60
age group 61 - 70
age group 71 - 80
overall
Prevalence versus Age
-1
-0,5
0
0,5
1
0 2 4 6
AGE CLASS
LO
G P
RE
VA
LE
NC
E
> 80 dB
> 90 dB
INCREASE OF PREVALENCE PER 10 YEARS of AGE
The slope of the line
LOG P(x + 10) = LOG P (x) + 0,367
P(x + 10) / P (x) = 2,3
Prevalence increases 2,3 fold every 10 years
Number of CI-CANDIDATES from log-plot
Overall in 2004
Population (18 – 100 years) = 12.700.000
> 80 dB > 90 dB
Prevalence 0,569 % 0,265 %
N (18 – 100) 72.263 33.655
Prevalence from the Differential log-plots
Σ = sum [ N(x - (x + 10)) * P(x - (x + 10)) ] x = 41, 51, 61, 71, 81, 91
HL > 80 dB > 90 dB
1994 59.873 30.394
2004 70.347 (72.263) 35.713 (33.655)
25 - 35%17.600- 24.600 8.900 (12.500)
FLUX N (>90 dB) 1th order approximation
1994 N(30-100) = 9.140.000 =>
2004 N(40-100) = 7.100.000
Survival ratio (migration included) = 0,84
2004 42.591
2005 33.869 x 0,84 = 28.450
10 years difference 14.141
FLUX / YEAR at > 90 dB1.414
RESERVOIR
35.713
BORN DEAF 200-24033 %
TO CI400
PASSING TRESHOLD60-80
DEAFENED 200ADULTS / CHILDREN 35 – 50 %
70 - 100
1.414 350 - 49025 – 30 %
FLOW DIAGRAM at > 90 dB
RESERVOIR
2000
BORN DEAF 12,5 - 1533 %
TO CI25
“40”
4 - 5
DEAFENED 12,5
ADULTS / CHILDREN 35 – 50 %
4 – 6,5
PASS THRESHOLD
90 22 - 2725 – 30 %
FLOW DIAGRAM at > 90 dBper MILLION INHABITANTS
Birth rate per 1000 inhabitants
• Austria 8.7 L’bourg 11.8
• Belgium 10.3 Netherlands 10.7• Denmark 10.9 Norway 11.3• Estland 10.2 Spain 10.0• Finland 10.4 Sweden 10.2• France 12.9 Swiss 9.7• Germany 8.2 Turkey 16.4• Greece 9.6• Italy 8.5 www.census.gov/ipc
Implantations per Million in 2007
0
5
10
15
20
25
30
Conclusions at > 90 dB
• A LARGE RESERVOIR of CI-POTENTIALS EXISTS (about 35.713)
GO-NO GO ratio unknown
• YEARLY FLUX to the RESERVOIR
1.414 PROGRESSIVELY DEAFENED200 – 240 NEONATES200 SUDDENLY DEAFENED
GO - NO GO ratio 35 %
• IMPLANTATION CAPACITY FAR BEHIND DEMAND
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