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Updated: Jun 21, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Health disparities in pediatric cochlear implantation: an audiologic perspective
Erin Kirkham1, Chana Sacks, Fuad Baroody
1University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
Insights
Pediatric cochlear implant audiologists perceive socioeconomic status impacts speech and language outcomes. They suggest improving services and parental education to address disparities in pediatric cochlear implantation (PCI).
Area of Science:
- Audiology
- Speech-Language Pathology
- Public Health
Background:
- Pediatric cochlear implantation (PCI) aims to improve speech and language outcomes in children with hearing loss.
- Socioeconomic status (SES) may influence access to care and habilitation, potentially affecting PCI outcomes.
- Understanding audiologists' perceptions is crucial for identifying disparities and developing targeted interventions.
Purpose of the Study:
- To determine if PCI audiologists perceive a negative effect of low SES on postimplant speech and language outcomes.
- To understand audiologists' perceptions of factors contributing to SES-related outcome disparities.
- To elicit suggestions from audiologists for improving outcomes in disadvantaged pediatric populations.
Main Methods:
- A national survey of 234 pediatric cochlear implantation (PCI) audiologists was conducted.
- 103 audiologists responded (44% response rate), with 98 completing all questions.
- Quantitative data were analyzed statistically, and qualitative responses underwent content analysis.
Main Results:
- 78% of respondents perceived that SES negatively affects postimplant speech and language outcomes.
- Perceived disparities were linked to parental factors (adherence, self-efficacy) and external factors (therapy access, resources).
- Key suggestions included improving PCI services, enhancing parental education, and refining candidacy requirements.
Conclusions:
- PCI audiologists recognize an SES-related disparity affecting speech and language outcomes.
- Addressing this disparity requires culturally sensitive efforts to increase healthcare access.
- Developing strategies to support parents in the at-home habilitation process is essential.
Objectives:
A national survey of pediatric cochlear implantation (PCI) audiologists was conducted with three aims: (1) to determine if PCI audiologists perceive within their clinical practice a negative effect of low socioeconomic status (SES) on postimplant speech and language outcomes; (2) to understand their perceptions of the underlying factors leading to outcome disparities; and (3) to elicit suggestions for improving outcomes in disadvantaged populations. We hypothesized that audiologists would perceive reduced speech and language outcomes within their lower SES patient population, and that this noted disparity would be related to parental adherence (compliance) and access to habilitation.
Design:
A survey containing 22 quantitative and open-ended questions was electronically mailed to a data base of 234 PCI audiologists. Forty-four percent (N = 103 of 234) responded to the survey, with the majority (98 of 103) answering all questions. Quantitative responses were analyzed using the Stata 9 statistical package with significance at p < 0.05. Qualitative responses were analyzed using standardized codebook and content analysis. Transcripts were read and coded for the main ideas expressed in each response. The codes were then analyzed for patterns and organized into subthemes that were then grouped into themes.
Results:
Seventy-eight percent (N = 76 of 98) of respondents perceived an effect of SES on postimplant speech and language outcomes. Qualitative responses uniformly demonstrated audiologists' perception that lower SES patient populations were more likely to experience reduced speech and language outcomes. Two major themes emerged in audiologists' explanations of SES-related disparities: internal factors of parental influence (i.e., parental self-efficacy, adherence, and habilitation carryover), and external factors (i.e., inadequate therapy and lack of available resources). Three primary suggestions were offered for reducing the disparity: improvement in cochlear implant services (92%), increased emphasis on parental education and intervention (87%), and the development of stricter candidacy requirements (15%).
Conclusions:
This study offers evidence to show that PCI audiologists note an SES-related disparity in the field of PCI. Respondents suggest the need for a broad and culturally sensitive effort to both increase access to qualified healthcare professionals and develop approaches that will aid parents in the at-home habilitation process.
