For many years, adults with severe hearing loss in both ears were eligible for reimbursement of only one cochlear implant (CI). Yet receiving two implants can make a significant difference in daily life, from following conversations at work or in social settings to identifying where approaching traffic is coming from. Professionals from Radboud university medical center in Nijmegen and UMC Utrecht took the lead in changing this situation. Working closely with professional associations, patient representatives, the Dutch National Health Care Institute (Zorginstituut Nederland), and the Dutch Association of Health Insurers (Zorgverzekeraars Nederland), they successfully helped change the policy so that a second cochlear implant will now be reimbursed for a group of eligible adults.
For people with severe hearing loss, a cochlear implant can be life-changing. The device stimulates the auditory nerve with electrical signals, enabling people to hear again. Each year, approximately 500 adults in the Netherlands receive a cochlear implant. However, even when individuals were deaf or severely hearing impaired in both ears, basic health insurance covered only one implant. For ENT surgeon Diane Smit of UMC Utrecht and Professor of Hearing & Implants Wendy Huinck of Radboud university medical center, this was reason enough to take action.
Although a single implant can substantially improve hearing, everyday situations often remain challenging. ‘In complete silence, many people can still follow a conversation reasonably well,’ says Diane Smit. ‘But how often is the world around us truly silent?’
Understanding speech in noisy environments, such as offices or social gatherings, can be particularly difficult. Wendy Huinck adds: ‘People with just one implant have to cope all day long in a world full of challenging listening situations. That requires enormous effort and energy. Some people are already exhausted halfway through their working day.’
Researchers in the Netherlands and abroad, including teams from the ENT departments of UMC Utrecht and Radboud university medical center, have spent years studying the benefits of hearing with implants in both ears. Their research demonstrated that people with two implants are better able to understand speech in background noise. During meetings involving multiple speakers, for example, they can more easily identify who is speaking. They are also better able to determine the direction sounds are coming from, an important advantage in situations such as traffic.
A second implant therefore offers more than improved speech perception alone. It can help people participate more easily in social activities and contributes to their safety and independence. As a result, a second cochlear implant can make a meaningful difference in daily functioning and overall quality of life.
Scientific evidence of clinical benefit does not automatically lead to reimbursement. That is why Diane Smit and Wendy Huinck took the initiative in 2023 to secure reimbursement for a second cochlear implant for adults. One central question guided their efforts: how do you determine the true value of better hearing?
‘In research, we can accurately measure how much people hear and understand with two implants compared with one’, Smit explains. ‘However, these measures do not fully capture what hearing with two ears means for people in everyday life.’
Together with ethicists, the researchers therefore explored whether the current methods used to evaluate treatments adequately reflect their broader benefits.
‘It is not just about clinical outcomes and treatment costs’, Huinck says. ‘It is also about people’s wellbeing and the opportunities a treatment creates for them. We need to give greater weight to that personal and societal value when making reimbursement decisions.’
To make reimbursement possible, Smit and Huinck collaborated with professional associations, patient organizations, health insurers, and cochlear implant centers at all Dutch university medical centers. According to Huinck, this collaboration was essential. ‘If you want to change healthcare, healthcare professionals must stand behind it together. You are not doing this for the patients of a single hospital, but for patients throughout the Netherlands. Together, you are stronger.’
Years of collective effort have now paid off. Adults with severe hearing loss in both ears who already use one cochlear implant may now be eligible for reimbursement of a second implant. Specialists will assess on an individual basis whether a second implant is expected to provide sufficient additional benefit.
This reimbursement is important not only for today’s patients, but also for future generations. ‘Approximately 500 adults receive a cochlear implant each year,’ says Smit. ‘Because of population ageing, we expect this number to continue increasing. Although people are living longer, hearing loss becomes more common as we grow older.’
For the researchers, this achievement marks a special moment. ‘As clinicians and researchers, we are constantly asking how we can help people hear as well as possible. Now we have truly made a difference for patients, not only for those we treat today, but also for patients ten, twenty, or even thirty years from now.’
A cochlear implant is intended for people with severe hearing loss who receive insufficient benefit from conventional hearing aids. Not everyone is eligible. For example, an implant may be less suitable for people who have been deaf for a long time or who have certain congenital abnormalities affecting hearing. Specialists therefore assess each patient individually to determine whether a cochlear implant is likely to provide meaningful benefit.
No. Adults with severe hearing loss in both ears will generally receive one cochlear implant first. This is followed by a period of rehabilitation and adaptation during which they learn to hear with the implant. Specialists at a cochlear implant center will then assess whether a second implant is likely to provide sufficient additional benefit and whether the patient meets the criteria for reimbursement. Eligibility depends on individual circumstances.
A second cochlear implant can be obtained through one of the cochlear implant centers at the academic medical centers in the Netherlands. If you already have a cochlear implant, you should contact your own CI center to discuss whether a second implant may be an option for you.
Possibly, if you are deaf or severely hearing impaired in both ears. Whether a second cochlear implant is appropriate and eligible for reimbursement depends on several criteria. Specialists from your own CI team can assess your situation and discuss the available options with you.
