In Hungary, the government has a special fund to allow up to 10 patients annually to receive multi-channel implants, including both Nucleus and Med EL devices. In Sao Paolo, Brazil, the government also sponsored a cochlear implant program to allow implantation of several devices every year. Clinical centers have also been established to implant Nucleus, Clarion, and Med EL devices in Argentina, Mexico, Columbia, and other South American countries. Overall, the total number of the multi-electrode implantation is not more than a few hundred in developing countries. Unless the device cost can be drastically reduced to a level compatible with the economic condition in developing countries, the multi-electrode implant will remain, as one South American doctor put it, a toy of the few rich or fortunate in these countries.
Infrastructure is generally less satisfactory in developing countries than in developed countries.
Review of published materials indicates that, at least, in China, Egypt and Saudi Arabia, patient selection and pre-surgical screening procedures have been standardized for cochlear implants and are in many ways similar to standards adopted in western countries. However, there are some distinctive differences in patient selection between developing and developed countries. For example, most Chinese doctors think that the presently available single-electrode implants should not be placed in children less than 10 years old. Given the limited funding from the government and the importance of having some initial success, it is unfortunate that clinicians have to deny patients access to cochlear implants because of their lower socio-economic status. Like their counterparts in developed countries, otological physicians have played the most critical role in the process of device research, development and distribution.