An outcomes study of cochlear implants in deaf patients. Audiologic, economic, and quality-of-life changes

Laryngeal cancer: quality-of-life and cost-effectiveness

BACKGROUND

The need to account for the cost of care is being imposed on clinicians by the corporate purchasers of health care. The cost-effectiveness of treatment for laryngeal cancer should be based on measurable and relevant clinical outcomes. Quality-of-life (QL) is a very important outcome, especially if survival is similar between two treatments.

METHODS

Using QL data gathered prospectively from a group of 46 patients with glottic cancer, the effects of radiotherapy (RT) are compared with those of surgery (total laryngectomy).

RESULTS

Surgery results in greater measurable dysfunction, especially of speech, but with respect to psychological functioning and general well-being, there are no major QL differences between patients treated surgically and those receiving RT.

CONCLUSIONS

Cost-effectiveness of surgery, from the perspective of patient-based QL outcome, is very similar to that for RT in advanced cancer of the larynx. Each center needs to carefully consider its outcomes and overall average costs per patient before deciding which treatment regimen is to be preferred. These results have implications for the organ-sparing regimens in the treatment of advanced laryngeal cancer.

Ethics of Cochlear Implantation in Young Children

Certain leaders of the Deaf community are attempting to generate opposition to cochlear implants in children by pitting the rights of deaf children and their families against the needs of deaf society. They have labeled physicians as unethical and CIs as “child abuse,” resulting in misunderstanding, anger, and violence. However, the arguments of these leaders are internally contradictory: they hold that deafness is not a disability but support disability benefits for the deaf; they maintain both that cochlear implants do not work and that they work so well that they are “genocidal” (i.e., they will eliminate deafness). Their positions oppose the ethical principles of beneficence and autonomy as they relate to self-determination and privacy. Ethical standards hold that the best interests of the child precede those of a special interest group and that parents have the responsibility to determine their children's best interests.