Unilateral Treatment Research Articles

Intense pulsed light treatment for hidradenitis suppurativa: a within-person randomized controlled trial

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of the intertriginous areas. HS affects hair follicles causing perifollicular inflammation, resulting in the formation of nodules and painful abscesses. Intense pulsed light (IPL) uses selective photothermolysis to destroy the hair follicles. To evaluate the effect of IPL hair removal as treatment for mild-to-moderate HS. We conducted a single-blinded, clinical randomized trial with patients with Hurley Stage I-II. Patients with symmetrical disease were randomized to monthly unilateral treatment of the axilla or groin. The contralateral side served as internal control. Concomitant treatment modalities for HS were not permitted throughout the study. Efficacy was assessed using Hidradenitis Suppurativa Clinical Response (HiSCR), modified Sartorius score (MSS) and patient-reported outcomes. A total of 17 patients completed the trial and were included in the analysis. HiSCR was not evaluated in patients without abscesses or inflammatory nodules pre-treatment. HiSCR was insignificantly different between the intervention side (8/12) and control side (4/10), P=0.467. There was, however, a significant reduction in regional MSS on the intervention side with a median score decreasing from 8.5 (IQR: 6.3-13.5) to 4.5 (IQR 1.8-8.0) post-treatment, P=0.006, and an insignificant score reduction in the control side from 6.0 (IQR: 4.5-8.3) to 5.0 (IQR: 2.5-9.0), post-treatment P=0.492. IPL hair removal resulted in a significant reduction on MSS on the treated area with no significant reduction on the control side. Our study suggests that IPL may be an effective treatment for mild-to-moderate HS.

Slice Functional Condylectomy and Piezosurgery: A Proposal in Unilateral Condylar Hyperplasia Treatment.

Condylar hyperplasia is a temporomandibular joint progressive disease characterized by an excessive growth of the mandibular condyle. Condylar overgrowth represents one of the most common causes of facial asymmetry in early adulthood. To date, there is not a clearly established origin of the disease: genetic, traumatic, infective, vascular, and functional factors are involved hypotheses. Clinically, condylar hyperplasia presentation is characterized by an asymmetry of the lower third of the face, deviation of the chin, inclination of the labial line and malocclusion. Several treatments have been proposed over the years in the treatment of mandibular condyle hyperplasia, but to date a gold standard has not been defined. Two are the main approaches: condylectomy and orthognathic surgery, isolated or in a combination. Many condylectomy technique differentiations have been developed: high, low, and proportional, are the most performed. In this technical note, the Slice Functional Condylectomy (SFC), a modification of the proportional condylectomy is presented.

Bilateral rTMS Shows No Advantage in Depression nor in Comorbid Depression and Anxiety: A Large Naturalistic Study

Background: The objective was to determine if adding low-frequency (LF) right-sided rTMS treatment to the standard high-frequency (HF) left-sided treatment, together referred to as bilateral treatment, confers any additional benefit for depressive or anxiety outcomes. Design/Methods: A retrospective chart review of patients treated with rTMS was conducted, from January 2015 through December 2018, yielding 361 patients. All patients were treated with a figure-of-8 coil for a major depressive episode, and their protocol was either HF left-sided treatment or bilateral treatment. The Generalized Anxiety Disorder 7-item scale (GAD-7) was the anxiety outcome measure, and the Patient Health Questionnaire (PHQ-9) was the depression outcome measure. Results: There was no significant difference in GAD-7 change scores between patients who had unilateral (GAD change=4.2) versus bilateral rTMS (GAD change=4.5). Unilateral rTMS patients had greater improvement in PHQ-9 than bilateral (7.2 vs. 5.0; P=.011). Patients switching from unilateral to bilateral treatment mid-course had overall poorer outcomes than patients who did not. Conclusions: This large, naturalistic study shows no advantage for bilateral treatment in any group or condition examined, and for depression outcomes, there may be a deficit with bilateral versus unilateral treatment. The results of this study have clinical applicability and sound a cautionary note regarding the use of combination protocols in rTMS treatment, given the greater time and expense of bilateral treatments.

The Effects of Endobronchial Coil Therapy on Right Ventricular Functions

Lung hyperinflation is an important therapeutic target in symptomatic emphysema patients. Endobronchial therapies that reduce end-expiratory lung volume are increasingly being used in advanced cases. However, there is paucity of data regarding the effects of these therapies on the heart functions. The aim of this study is to evaluate the right ventricular functions before and after the procedure in patients who underwent endobronchial coil therapy (EBCT).Patients who were between 18 and 80 years of age and scheduled for EBCT with GOLD 3-4 were enrolled in the study. Right heart functions were evaluated using MPI, TAS, TAPSE. Right atrium area and maximum velocity of tricuspid regurgitation were also noted.A total of 23 patients were enrolled in the study. 21 patients underwent bilateral intervention, while only 2 patients received unilateral treatment. There was an improvement in MPI (0.49 ± 0.15 vs 0.39 ± 0.11, p < 0.001) and TAS (11.6 (9 − 15) vs 13.2 (9.80 − 17.0), p = 0.001). Peak TRV (2.52 ± 0.6, 2.38 ± 0.6, p = 0.02) and PASP values were lower in the post-operative period (41.15 ± 5.94 vs 36.83 ± 8.01 p = 0.019).In this current study, we found improved echocardiographic RtV parameters in patients who received EBCT treatment.

The Efficacy of Fixation of Unilateral Mandibular Angle Fracture with Single 3D Plate vs Single Miniplate Using Transbuccal Approach.

The management of mandibular angle fractures is often challenging and results in the highest rate of complications. The optimal treatment modality still remains controversial. This study was done to compare the treatment outcomes of single 3D plate versus single miniplate. The objective was to compare and evaluate the clinical and radiological outcome in patients who underwent treatment with single 3D plate versus single miniplate using transbuccal approach for unilateral angle fractures with other associated mandibular fractures. A randomized control study was done in 12 patients with unilateral angle fracture who were divided into two groups. Group A patients were treated using single 3D plates, and Group B patients were treated using single miniplates. Study parameters were evaluated at different time intervals. The results of the study showed that postoperatively in Group A, fracture reduction, occlusion and mouth opening were comparatively better than Group B. Hardware failure was seen in one patient in Group B. Postoperative morbidities showed no statistical difference. The single 3D plates showed a statistically insignificant advantage over single miniplates, although clinically Group A proved better than Group B with respect to the study parameters. Therefore, we recommend the use of single 3D plates for effective unilateral angle fracture treatment. More studies are required to prove the significant statistical significance.

Do Not Stahl: Analyzing 10-Year Trends of Nonsurgical Ear Molding as Early Intervention for Congenital Ear Anomalies

BACKGROUND: The senior author has employed ear molding as a treatment for infant ear anomalies for over 12 years, and it is now his preferred approach to almost all ear anomalies. During this period, we have observed trends in our treatment approach secondary to our experiences. The purpose of this study is to evaluate the classification of presenting anomalies, duration of treatment, timing of treatment, parent satisfaction, complications, and any identifiable barriers to care. METHODS: The authors conducted a retrospective review of infants who underwent ear molding with the EarWell or Infant Ear systems by a single surgeon over a 10-year period. Each case was evaluated for key patient demographics, presenting anomalies, treatment duration, device reapplication, complications, outcome satisfaction, and need for adjunct treatment. RESULTS: Two hundred forty-six infants with a total of 385 ears were evaluated. Of these patients, 107 underwent unilateral treatment and 139 underwent bilateral treatment. Presenting anomalies included Stahl’s ear (n = 9), lidding/lop (n = 23), helical rim (n = 70), prominent (n = 26), cupping (n = 7), conchal crus (n = 8), and mixed (n = 92). Age at the start of treatment ranged from 3 to 156 days with 61.8% of patients presenting before 3 weeks. Average duration of treatment was 30.5 days and did not vary significantly with age at presentation (P = 0.653) or laterality (P = 0.630). Duration of treatment was shortest for ears exhibiting lidding/lop anomalies (22.8 days) and significantly longer for ears exhibiting a combination of at least 2 anomalies (32.4 days; P < 0.01). Unilateral treatment required an average of 0.96 device replacements compared with 1.49 for bilateral treatment. Adverse events occurred in only 19.1% of cases with skin breakdown (n = 26) under the device being the most common. The senior author performed approximately 12.4 cases per year between January 2010 and December 2016 and 53.0 cases per year between January 2017 and December 2019. Average income for treated patients based on zip code was estimated to be $113,087 and treatment was covered by insurance in 244 of 246 cases. At least 1 parent expressed satisfaction with outcomes in 92.0% of cases. CONCLUSIONS: This study shows that ear molding achieves successful outcomes with high satisfaction and low complication rates across a wide range of presenting anomalies and ages. Treatment of older-presenting infants does not vary significantly in complexity or duration compared with younger infants. There has been a rise in the number of ear molding cases performed by the senior author over the last 10 years, indicating increasing interest in nonsurgical correction of auricular anomalies. The overwhelming majority of patients in this study were insured and of high socioeconomic status, suggesting need for broadening awareness and access to ear molding as a treatment option.

Individual vs. Social Learning: An Experiment

We study the effectiveness of social learning when subjects can also learn individually. In the baseline treatment, a subject observes a sequence of private signals about an unknown state of the world and chooses an action to match the state. In the unilateral social learning treatment, a subject observes the lagged actions of another subject in the baseline condition in addition to her own private signals. In the bilateral treatment, two subjects observe each other's lagged actions in addition to their own signals. While beliefs and decisions become more accurate over time, social learning fails in the sense that accuracy is not improved by observing another subject's actions. The median subject extracts 1.6% of the available information from her partner's action in the bilateral treatment and about 20% of the available information in the unilateral treatment. We also find evidence of correlation neglect: subjects in the bilateral treatment treat the actions of others as if they do not depend on their own past histories.

Self-Reported and Performance-Based Outcome Measures Estimation Using Wearables After Unilateral Total Knee Arthroplasty

Total knee arthroplasty is a common surgical treatment to improve ambulatory function for individuals with end-stage osteoarthritis of the knee. Functional and self-reported measures are widely used to assess functional ability and impairment before and after total knee arthroplasty. However, clinical assessments have limitations and often provide subjective and limited information. Seamless gait characteristic monitoring in the real-world condition is a viable alternative to address these limitations, but the effectiveness of using wearable sensors for knee treatment is unclear. The purpose of this study was to determine if inertial gait variables from wearable sensors effectively estimate the questionnaire, performance (6-min walk test, timed up and go, and 30-s chair stand test), and isometric measure outcomes in individuals after unilateral total knee arthroplasty. Eighteen subjects at least 6 months post-surgery participated in the experiment. In one session, three tasks, including self-reported surveys, functional testing, and isometric tests were conducted. In another session, the participants' gait patterns were measured during a 1-min walking test at their self-selected gait speed with two accelerometers worn above the lateral malleoli. Session order was inconsistent between subjects. Significant inertial gait variables were selected using stepwise regressions, and the contributions of different categories of inertial gait variables were examined using hierarchical regressions. Our results indicate inertial gait variables were significantly correlated with performance test and questionnaire outcomes but did not correlate well with isometric strength measures. The findings demonstrate that wearable sensor-based gait analysis may be able to help predict clinical measures in individuals after unilateral knee treatment.

Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience

BackgroundThe management of bilateral intracranial vertebral artery dissecting aneurysms (IVADAs) is controversial, and requires the development of endovascular treatment modalities and principles. We aim to investigate the endovascular treatment strategy...

A Dosimetric Comparison of Oral Cavity Sparing in the Unilateral Treatment of Early Stage Tonsil Cancer: IMRT, IMPT, and Tongue-Deviating Oral Stents

IntroductionTongue-deviating oral stents (TDOS) are commonly used during unilateral neck radiation therapy to reduce unnecessary dose to nontarget oral structures. Their benefit in the setting of highly conformal treatment techniques, however, is not defined. The goal of this study was to investigate the potential benefit of TDOS use on dosimetric parameters in unilateral intensity modulated radiation therapy (IMRT) and intensity modulated proton therapy (IMPT). MethodsA total of 16 patients with T1-2 tonsil cancer treated at a single institution were selected, of which 8 were simulated/treated with a TDOS and 8 without a TDOS. All received definitive unilateral IMRT to a dose of 66 Gy in 30 fx. IMPT plans were generated for each patient for study purposes and optimized according to standard institutional practice. ResultsFor IMRT plans, the presence of a TDOS (vs without) was associated with a significantly lower oral mucosa mean dose (31.4 vs 35.3 Gy; P = .020) and V30 (42.7% vs 57.1%; P = .025). For IMPT plans, the presence of TDOS (vs without) was not associated with any improvement in oral mucosa mean dose (18.3 vs 19.9 Gy; P = .274) or V30 (25.0% vs 26.2%; P = .655). IMPT plans without TDOS compared with IMRT plans with TDOS demonstrated reduced oral mucosa mean dose (P < .001) and V30 (P < .001). ConclusionThe use of a TDOS for the unilateral treatment of well-lateralized tonsil cancers was associated with oral mucosa sparing for IMRT, but not for IMPT. Moreover, mucosa sparing was improved for IMPT plans without a TDOS compared to IMRT plans with a TDOS.

American Society for Stereotactic and Functional Neurosurgery Position Statement on Magnetic Resonance-Guided Focused Ultrasound for the Management of Essential Tremor.

Magnetic resonance-guided focused ultrasound thalamotomy is a novel tool in the neurosurgical armamentarium for management of essential tremor (ET). Given the recent introduction of this technology, the American Society of Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, including confirmed diagnosis of ET, failure to respond to first-line therapies, disabling appendicular tremor, and unilateral treatment are detailed, based on current evidence. Contraindications to therapy are also detailed. Finally, the evidence and authority on which the ASSFN bases this consensus position statement is detailed.

Comparison of the therapeutic effect of Meibomian Thermal Pulsation LipiFlow\xae on obstructive and hyposecretory meibomian gland dysfunction patients

PurposeTo explore the effect of Meibomian Thermal Pulsation LipiFlow® on obstructive and hyposecretory meibomian gland dysfunction.MethodsTwenty-five subjects diagnosed with obstructive meibomian gland dysfunction (OMGD) and another 25 hyposecretory meibomian gland dysfunction (HMGD) patients were collected receiving the unilateral treatment with LipiFlow®. We evaluated the parameters variables including Standard Patient Evaluation of Eye Dryness (SPEED), Ocular Surface Disease Index (OSDI), Schirmer I test (SIT), noninvasive keratographic breakup time (NIKBUT), tear meniscus height (TMH), and lipid layer thickness (LLT), partial blink rate (PBR), meibomian gland loss, meibomian gland morphology with LipiView®. Meibomian gland expressibility and secretion quality were evaluated for OMGD subjects. All the results were recorded pre-therapy and 4 weeks, 8 weeks, 12 weeks post-therapy.ResultsSPEED, OSDI, and PB decreased, meanwhile, NIKBUT, TMH, SIT, and LLT increased compared with baseline in both groups after treatment (P < 0.001), whereas the magnitude of the improvement in the OMGD group was greater than that in the HMGD group (P < 0.001). There was no significant posttreatment structural meibomian gland change in both groups. The meibomian gland expressibility and secretion quality score increased after treatment in the OMGD group (P < 0.001).ConclusionsThe Meibomian Thermal Pulsation LipiFlow® is effective for both obstructive and hyposecretory meibomian gland dysfunction and the therapeutic effect on obstructive meibomian gland dysfunction is greater than that on hyposecretory meibomian gland dysfunction.

Pembrolizumab-associated thrombotic microangiopathy in a patient with urothelial cancer: a case report and literature review

BackgroundPembrolizumab, a highly selective humanized monoclonal IgG4κ isotype antibody against PD-1, is one of the immune checkpoint inhibitors approved for treatment of various cancers. The most frequent immune-related adverse events include skin, gastrointestinal, and endocrine abnormalities. In rare cases, however, adverse events on the kidney do occur.Case presentationWe here report a case of acute kidney injury presenting thrombocytopenia and hemolytic anemia with the presence of schistocytes, which developed in a 68-year-old man with urothelial cancer, 7 months after initiation of pembrolizumab treatment (10 cycles) and 3 weeks after treatment cessation. The patient had previously undergone unilateral nephrectomy and prior treatment with combined gemcitabine and carboplatin regimen. Although corticosteroid, hemodialysis, and plasma exchange were initiated, the patient died within a few days of respiratory failure. Pathological examination at autopsy revealed multiple carcinomas including the lung, liver, and spine, together with the diagnosis of thrombotic microangiopathy by electron microscopy findings of the renal tissue. To our knowledge, this is the first report describing severe thrombotic microangiopathy in a patient possibly associated with pembrolizumab, leading to death.ConclusionPhysicians should be aware of this potential side effect in patients presenting acute kidney injury and thrombocytopenia.

Unilateral spatial neglect rehabilitation supported by a digital solution: two case-studies.

Digital solutions for unilateral spatial neglect (USN) assessment and treatment are nowadays of great interest, because of both the possibility of combining them with other rehabilitation practices, and the easy-to-understand data and indicators they collect. The ReMoVES platform, developed in DITEN laboratories, is conceived in the Assistive Technologies framework and provides motor and cognitive exergames and activities to be performed in conjunction with traditional rehabilitation. In this work, two case-studies, related to the USN rehabilitation, are presented. The combination of cognitive therapy, delivered by the ReMoVES platform, and transcranial direct-current stimulation (tDCS) technique was used as rehabilitation treatment for both the patients. Data collected at the beginning or at the end of the rehabilitation process, or also during the treatment sessions, are shown and discussed in this paper. This work is a preliminary part of a wider one, that will be conducted involving many different rehabilitation centers, aimed at proving the validity of such an approach to USN treatments.

Historical landmarks of the management of major urban logistics projects in Imperial Timisoara

This article follows an holistic approach to the management of the major urban logistics projects of Imperial Timisoara. The research conducted so far has been based on unilateral treatments: either exclusively historical or engineering. Research of such projects requires multi-scientific and multidisciplinary treatment angles. Our investigative optics is a managerial-holistic one, which integrates, besides the historical, technical / technological aspects, the architectural aspects, along with the multicultural, socio-human, ethnic, anthropological, urban, structural, processual and functional aspects. In this sense, the strategic references of urban essence are related to the potential of Timisoara city to have been able to carry out such projects, in the contexts specific to the different periods of its logistic development. The multitude of researched data sources, information and documents enables us to innovate the approach of major urban logistics projects, using the logic of public management, in a holistic, integrative vision. We are convinced that such research, in such a way, will contribute substantially to a deeper understanding of Timisoara's contribution to his own Europeanization and the region he was part of, the Imperial Historical Banat.

Precision Targeted Ablation of Fine Neurovascular Structures In Vivo Using Dual-mode Ultrasound Arrays

Carotid bodies (CBs) are chemoreceptors that monitor and register changes in the blood, including the levels of oxygen, carbon dioxide, and pH, and regulate breathing. Enhanced activity of CBs was shown to correlate with a significant elevation in the blood pressure of patients with hypertension. CB removal or denervation were previously shown to reduce hypertension. Here we demonstrate the feasibility of a dual-mode ultrasound array (DMUA) system to safely ablate the CB in vivo in a spontaneously hypertensive rat (SHR) model of hypertension. DMUA imaging was used for guiding and monitoring focused ultrasound (FUS) energy delivered to the target region. In particular, 3D imaging was used to identify the carotid bifurcation for targeting the CBs. Intermittent, high frame rate imaging during image-guided FUS (IgFUS) delivery was used for monitoring the lesion formation. DMUA imaging provided feedback for closed-loop control (CLC) of the lesion formation process to avoid overexposure. The procedure was tolerated well in over 100 SHR and normotensive rats that received unilateral and bilateral treatments. The measured mean arterial pressure (MAP) exhibited measurable deviation from baseline 2–4 weeks post IgFUS treatment. The results suggest that the direct unilateral FUS treatment of the CB might be sufficient to reduce the blood pressure in hypertensive rats and justify further investigation in large animals and eventually in human patients.

Investigation of the Effects of Leg Dominance on Cross-Transfer of Flexibility after a Unilateral Treatment with Foam Roller - A Pilot Study

Investigation of the Effects of Leg Dominance on Cross-Transfer of Flexibility after a Unilateral Treatment with Foam Roller - A Pilot Study

Added value of contrast-enhanced mammography (CEM) in staging of malignant breast lesions\u2014a feasibility study

ObjectivesThe aim of this feasibility study was to evaluate the added value of contrast-enhanced mammography (CEM) in preoperative staging of malignant breast lesions, beyond standard assessment with digital mammography and ultrasound, as a base for a future prospective randomized trial.Materials and methodsForty-seven patients, with confirmed or strongly suspected malignant breast lesions after standard assessment (digital mammography (DM) and ultrasound (US)), scheduled for primary surgery, were invited to undergo CEM as an additional preoperative procedure. The primary endpoint was change in treatment due to CEM findings, defined as mastectomy instead of partial mastectomy or contrariwise, bilateral surgery instead of unilateral or neoadjuvant treatment instead of primary surgery. Accuracy in tumour extent estimation compared to histopathology was evaluated by Bland-Altman statistics. Number of extra biopsies and adverse events were recorded.ResultsIn 10/47 patients (21%), findings from CEM affected the primary treatment. Agreement with histopathology regarding extent estimation was better for CEM (mean difference − 1.36, SD ± 18.45) in comparison with DM (− 4.18, SD ± 26.20) and US (− 8.36, SD ± 24.30). Additional biopsies were taken from 19 lesions in 13 patients. Nine biopsies showed malignant outcome. No major adverse events occurred.ConclusionThe feasibility of preoperative additional CEM was found to be satisfactory without any serious negative effects. Results imply an added value of CEM in preoperative staging of breast cancer. Further evaluation in larger prospective randomized trials is needed.Trial registrationClinicalTrials.gov, NCT03402529. Registered 18 January 2018—retrospectively registered

Unilateral or Bilateral Percutaneous Endoscopic Debridement and Lavage Treatment for Lumbar Spinal Tuberculosis

To compare the clinical outcome between bilateral percutaneous endoscopic debridement and lavage (PEDL) and unilateral PEDL treatment for lumbar spine tuberculosis (LST). A total of 40 patients with LST who underwent either bilateral PEDL (group A) or unilateral PEDL (group B) were reviewed. Perioperative parameters were assessed by operative time, intraoperative fluoroscopy times, and days of postoperative continuous irrigation and vacuum drainage. Clinical outcomes were evaluated in the Oswestry Disability Index (ODI), visual analog scale (VAS), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All patients were followed-up for at least 18months after treatment. The average operative time and intraoperative fluoroscopy time were increased in group A compared with those in group B. There was no statistical significance between the 2 groups in postoperative continuous irrigation and vacuum drainage days. The ESR and CRP curves in the 2 groups showed a similar trend during 18-month follow-up. The VAS and ODI in the 2 groups significantly decreased 6 and 18 months postsurgery. There was no significant difference in the incidence of complication between the 2 groups. Two procedures yielded comparable and satisfactory results. Unilateral PEDL showed shorter operative time and decreased intraoperative fluoroscopy times compared with bilateral PEDL. We suggest the use of unilateral PEDL rather than bilateral PEDL in the treatment of LST.

Lifetime cost of unilateral cochlear implants in adults: a Monte Carlo simulation.

Due to increasing prevalence of hearing loss and relaxation of candidacy criteria of cochlear implant (CI) supply, the number of implantations is likely to further increase. Statutory health insurances are facing ever more urgent financing challenges since CI treatment causes high life-long costs. Additionally, increasing life expectancy and earlier implantation may extend therapy time and cost. With every case being individual, this study aims to calculate the possible lifetime cost of unilateral CI treatment in adults including stochastic uncertainties. Taking a statutory health insurance perspective, relevant cost components of CI therapy and their values were identified. The Monte Carlo method was used to simulate lifetime cost considering age at first implantation and distributions of costrelevant variables. A sensitivity analysis was conducted to determine the most crucial variables impacting on lifetime cost. Lifetime cost of CI treatment varies according to age at first implantation, respectively remaining lifetime; the earlier the implantation, the higher the overall cost. According to our simulation, the average lifetime cost for an adult patient first implanted between the age of 20-80 is at 53,030 € (present value). Cost of implantation and periodic speech processor exchanges show the highest impact on the total cost. Health care systems could face rising expenses for CI supply by technical development. Innovative life-long CIs could achieve significant savings per case that could finance additional implant cost. Until then, further targeted research will be required. CI-related cost for statutory health insurance crucially depends on the patient-side demand for cochlear implants. Therefore, cost forecasts must also consider the development of demand.