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Clinical ethics
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Medical and bioethical considerations in elective cochlear implant array removal
  1. Maryanna S Owoc1,
  2. Elliott D Kozin1,2,
  3. Aaron Remenschneider1,2,
  4. Maria J Duarte1,2,3,
  5. Ariel Edward Hight4,
  6. Marjorie Clay5,6,
  7. Susanna E Meyer7,
  8. Daniel J Lee1,2,
  9. Selena Briggs2,8,9
  1. 1 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  2. 2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  6. 6 Department of Philosophy, Worcester State University, Worcester, MA, USA
  7. 7 Department of Communication Sciences and Disorders, Worcester State University, Worcester, Massachusetts, USA
  8. 8 Division of Otolaryngology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  9. 9 Department of Otolaryngology, Georgetown University School of Medicine, Washington, DC, USA
  1. Correspondence to Dr Elliott D Kozin, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Elliott_Kozin{at}meei.harvard.edu

Abstract

Objective Cochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.

Data sources We address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.

Review methods A systematic review using three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.

Conclusions The medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.

Implications for practice Similar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family’s desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education.

  • clinical ethics
  • ethics
  • health care for specific diseases/groups
  • informed consent
  • surgery

http://dx.doi.org/10.1136/medethics-2016-103655

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    Footnotes

    • i Deaf, with a capital ‘D,’ is used throughout the paper to refer to an individual who identifies with the Deaf community: a large community of individuals in USA who are deaf (ie, have no functional hearing), use sign language or other means of nonverbal communication and do not endorse CI use. Whereas deaf, with a lower case ‘d,’ is used to describe the loss of functional hearing.

    • MSO and EDK contributed equally.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Beth Israel Deaconess Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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