title: The challenges of starting a cochlear implant programme in a developing country.
abstract: OBJECTIVE
  Deafness is indeed a silent disability in many parts of the world, and the majority of people who have hearing impairment live in developing countries. With rising economy and developing nations becoming hub of industrialization, hearing loss may increase in these countries. In this review, the authors have elected to focus the discussion on India to frame the challenges of cochlear implants in a developing country. This article reviews the common causes of hearing loss, the challenges faced by those with hearing impairment and why the penetration of these devices is low and also reviews some reasons for the inability of the government to support the implant programme in India.
  
  
  RESULTS
  Early identification of hearing is crucial towards ensuring appropriate hearing rehabilitation; it is, however, challenged by various factors, including public awareness, absence of a national new born screening programme, accessibility to diagnostic centres, availability of trained personnel and equipment and patient affordability. Cochlear implants are a proven auditory rehabilitative option for individuals with severe to profound sensorineural hearing loss, who otherwise do not benefiting from hearing aids. Nevertheless, only a small percentage of these individuals receive cochlear implants, and cost remains a leading prohibitive factor, particularly in developing countries. For example, in India, the personal average annual income is well below US $2000, whereas these devices cost between $12,000 and $25,000, exclusive of hospital and staff fees. Hence, the technology is virtually unavailable to the masses.
  
  
  CONCLUSIONS
  To overcome the cost limitation of those who would benefit from cochlear implants countries such as India and China have started to develop their own indigenous implants.
authors.affiliation: aDr Kumaresh ENT Clinic, Bangalore, India bDepartment of Otolaryngology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada cDepartment of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Kumaresh
authors.initials: K
authors.lastname: Krishnamoorthy
authors.forename: Ravi N
authors.initials: RN
authors.lastname: Samy
authors.forename: Nael
authors.initials: N
authors.lastname: Shoman
mesh_terms: D002681:China; D019929:Cochlear Implantation; D003906:Developing Countries; D006319:Hearing Loss, Sensorineural / Q000534:rehabilitation; D006801:Humans; D007194:India; D019986:Persons with Hearing Disabilities / Q000534:rehabilitation; D016730:Program Development; D011474:Prosthesis Design; D012046:Rehabilitation / Q000458:organization & administration*