By Holly Chik
With a growing number of Chinese affected by hearing loss, an Australian implant maker is leveraging the special medical tourism zone in Hainan to provide faster access to its latest device.
Cochlear introduced its new smart system in China in June, making the country one of the first global markets to launch the technology – through Hainan, the southern island province, and Hong Kong.
Introducing it via the Boao Lecheng international medical tourism pilot zone has meant patients can receive implants in the initial launch phase instead of waiting years for the foreign medical device to enter the Chinese market.
Unlike hearing aids that amplify sound, the implant bypasses damaged hair cells in the inner ear and directly stimulates the auditory nerve with electrical signals from an external processor equipped with a noise-cancelling microphone.
Chief technology officer Jan Janssen said the implant best helped users with severe and profound hearing loss for whom traditional hearing aids were no longer effective.
“Merely amplifying or cleaning up the sound … is no longer delivering an optimal [solution] for the user,” he said. “It is because the hair cells that transfer incoming acoustic vibrations into stimulation of the hearing nerve are no longer functioning, or too many of them are damaged.”
He said after an implant operation, it could take a few weeks to several months for the brain to relearn hearing and adapt to converting electrical stimulation into speech comprehension.
In a new upgrade, the implant is equipped with internal memory and upgradeable firmware – meaning it can receive software updates throughout its design lifetime of 75 years and measure how nerves respond to stimulation.
Janssen said the new internal memory stored a copy of a patient’s stimulation needs, which was previously only kept in the external sound processor.
“For people who have received the Cochlear implant, losing the processor, which happens quite regularly, or if it is broken or a dog is chewing on it, would mean an emergency,” he said.
“Imagine that you are a professional who relies on spoken communication. You probably have to put everything that you’re doing for the rest of the day on hold until you hear again.”
He said that in the past the wearer would have to seek help from an audiologist to set up a new processor, but the new system meant a replacement processor could be couriered to or picked up by the user “who will be back on air in 20 seconds” once they put it on.
Hearing loss is a growing public health concern in China. Around 40 per cent of the Chinese population – or 561 million people – will have hearing loss by 2034, Harbin Medical University researchers projected last year.
In 2019, nearly 430 million people in China experienced hearing loss, with more than 95 million having moderate-to-complete hearing loss, according to the study published in the peer-reviewed journal Public Health.
The researchers said ageing was a key factor in hearing loss for adults, while ear infections were the main cause for children aged under 10.
In older adults, losing the ability to hear has been linked to social isolation, depression and a higher risk of falling, among other health issues.
Hearing loss has also been identified as a risk factor for dementia. While the condition is often untreated, scientists have found growing evidence that treating hearing loss decreases the risk of dementia, according to the 2024 Lancet Commission on dementia.
The researchers recommended to “make hearing aids accessible for people with hearing loss and decrease harmful noise exposure to reduce hearing loss”.
In a 2022 study, Fudan University researchers in Shanghai found that hearing impairment was related to cognitive decline, brain atrophy and accumulation of tau protein, a hallmark pathology of Alzheimer’s disease.
Around 50,000 people in China have received the Cochlear implant since the company entered the Chinese market 30 years ago – accounting for more than half the implant recipients in the country, according to the company.
But that is only a fraction of those who might benefit from a hearing implant.
Li Xinyu, general manager of Cochlear China, said the company estimated that at least 10 million people in the country experienced severe, profound and complete hearing loss, and that number was expected to rise given the rapidly ageing population.
“The penetration is very low,” Li said. “We hope, as an industry with all the relevant key stakeholders being aligned and engaged, we can fast-track China’s progress in terms of cochlear implant penetration percentage to be close enough to advanced countries’ level [at] about 10 to 15 per cent in the next five to 10 years.”
Around 10.5 per cent of potentially eligible adults in Australia have received cochlear implants, according to a paper published by scientists at the Ear Science Institute Australia in May.
Li said the high uptake of hearing implants in children in China created a “parallel world” compared to the low levels seen in adults.
Thanks to nationwide newborn hearing screening and financial support, the proportion of hearing-impaired students in mainstream education grew from a quarter to more than half from 2001 to 2020, according to an article published in February in the China CDC Weekly.
More than 10 regions – including Shanghai, Jiangsu and Zhejiang – have gradually included cochlear implants in their basic medical insurance coverage, the research team led by Shanghai Jiao Tong University said.
“The first centralised procurement programme will significantly reduce cochlear implant costs from over 200,000 yuan (US$27,915) to approximately 50,000 yuan after March 2025, substantially improving intervention accessibility for hearing-impaired newborns,” they said.
Li said Hainan’s special health zone “significantly shortens” the delay in China receiving the latest medical technologies compared to Western countries. For now, those who wish to receive the new implant will have to travel to Hainan for the one-hour operation.
“It is certainly a very powerful platform companies can leverage in terms of accelerating new product introduction, especially the latest global technology, into China,” Li said.
He said Chinese regulatory approval usually came at least two years after approvals were granted by the European Union, United States and Australia.
“Launching products first in the special zone gives us the opportunity to prepare our clinical atlas … which is typically required by the National Medical Products Administration for the mainland approval.”
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