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Medical and bioethical considerations in elective cochlear implant array removal
Maryanna S Owoc1, Elliott D Kozin1,2, Aaron Remenschneider1,2
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Journal of Medical Ethics
|September 27, 2017
Summary
Elective cochlear implant (CI) removal is uncommon. Patient desires are paramount, provided they are well-informed and medically fit for surgery, guiding ethical CI explantation decisions.
Area of Science:
- Otolaryngology
- Bioethics
- Audiology
Background:
- Cochlear implant (CI) explantation for non-medical reasons is poorly understood.
- This study explores elective CI removal, considering medical, audiological, and ethical viewpoints.
Purpose of the Study:
- To provide data and expert commentary on elective cochlear implant removal.
- To guide clinical decision-making and formulate guidelines for CI explantation.
Main Methods:
- Case report of elective CI removal.
- Systematic literature review on CI benefits, complications, and explantation.
- Expert discussion involving a surgeon, audiologist, bioethicist, CI user, and Deaf community member.
Main Results:
- Medical risks of explantation include surgical complications, anesthesia risks, cochlear ossification, and poor hearing outcomes.
- Ethical considerations emphasize beneficence, non-maleficence, and patient autonomy.
- Patient desires are paramount if medically fit and well-informed.
Conclusions:
- Elective cochlear implant explantation requires a multidisciplinary approach centered on patient and family desires.
- Clinical decisions, patient counseling, and education should be informed by these findings.
