New expectations: pediatric cochlear implantation in Japan

FUNDING FOR COCHLEAR IMPLANTS: The Japanese health-care system provides universal health coverage for the entire 127 million population of Japan. This includes all aspects of cochlear implantation, from diagnosis to implantation to mapping and habilitation aftercare. Japan has the third largest developed economy; however, the uptake rate for cochlear implants is lower than that of countries with similar economic status. Japan has an uptake rate of approximately 1% of potentially suitable subjects of all ages, compared with 5.6% in the USA.

In Japan, about 55% of cochlear implant recipients are children of less than 18 years of age. This represents an increase of 20% in the last 10 years, with a relative increase in the numbers of children receiving implants compared with the numbers of adults. However, only 3-4% of children under the age of 3 years are being implanted at less than 18 months of age. This is in accordance with the Japanese ENT Academy's guidelines, which currently puts the minimum age limit for implants in children at 18 months.

For hearing loss was first piloted nationally in Japan in 2000. Funding for screening subsequently stopped in 2005, though the national treasury provided a further 2 years' funding. Since 2007 local government organizations have been given responsibility to support these screening programs, but there remains considerable variation in funding between different prefectures. In one prefecture, Okayama, 95% of babies were screened and followed up for 2 years. However, the support system for children who need further diagnostic testing after screening remains insufficient.

When diagnosed, children with hearing loss are referred for counselling, hearing aids and habilitation. The responsibility for these is divided between the Ministry of Health and Welfare (including surgery, device programming, and therapy) and the Ministry of Education. Schools for the deaf and preschool hearing impaired education centers have had most of the responsibility for early intervention, educational choices and referral for cochlear implantation. In the past 98% of schools for children with hearing loss have used communication methods relying mostly on visual cues. In recent years, however, there has been a shift toward 'inclusive' mainstream education. Between 2008 and 2011 the number of children with cochlear implants in special needs schools increased to 16%. It is now estimated that 67% of children with cochlear implants may now be in mainstream schools. There is still the need for support services for these implanted children attending mainstream schools, with adequate provision of resources.

Cochlear Implantation has had a significant role in changing the medical management and education of children in Japan with hearing loss. Much remains to be done, though the situation has greatly improved in recent years and continues to do so.