Enter the dragon – China's journey to the hearing world

CONTEXT: China's population of 1.3 billion represents nearly 20% of the world's population. The current live birth rate in China is 17 million per year, compared with 4.1 million in the USA in 2009. Ministry of Health figures from China identify 115 000 children under the age of 7 years with severe-to-profound deafness and 30 000 babies born each year with hearing impairment. NEWBORN SCREENING: Universal Newborn Hearing Screening (UNHS) has been implemented in China since 1999. By 2010 UNHS was implemented in 20 of the 32 Chinese provinces. In large cities 95% of babies are screened in hospital-based programs. In more remote areas babies with high-risk factors for hearing loss are referred to screening centers within 1 month of birth and leaflets about identifying deafness are distributed. COCHLEAR IMPLANTS: Since 1995 more than 10 000 people in China have received cochlear implants (CIs) and 85% of these implant recipients have been children under the age of 7 years. FINANCING OF CIS: China is in the process of developing a national reimbursement scheme for medical care. The first multichannel implant was performed in 1995. In 2005, a private financier provided more than 1500 implants for children under the age of 5 years. In 2009, the Chinese government set up a project to implant 1500 children aged 1–5 years over the next 3 years, with provision of the equivalent of US$65.4 million to pay for the devices, surgery, mapping, and rehabilitation. By 2011, the government had agreed to fund implants for an additional 17 000 children over 4 years. TRAINING OF PROFESSIONALS: Schemes have been developed to train surgeons, Audiologists, and those involved in rehabilitation of implanted children in China. OUTCOME ASSESSMENT: Standardized outcome tests are being developed for CI recipients. There are two large-scale ongoing outcome studies in progress. CI penetration in China is currently less than 5% of potential pediatric candidates, but cochlear implantation is continuing to expand at great speed, and it is hoped that the infrastructure and capacity will continue to grow and develop.