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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Barriers to the early cochlear implantation of deaf children
Elizabeth B Lester1, Jeffrey D Dawson, Bruce J Gantz
1Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
Insights
Timely cochlear implants (CIs) for deaf children are hindered by factors like insurance and referrals. Ensuring newborn hearing screening (NBHS) and educating parents on early intervention are crucial for timely CI access.
Area of Science:
- Audiology
- Pediatric Health
- Health Services Research
Background:
- Congenitally deaf children require timely cochlear implants (CIs) for optimal language development.
- Delays in CI access can significantly impact long-term outcomes.
- Understanding barriers to timely CI is essential for improving pediatric hearing healthcare.
Purpose of the Study:
- To identify social and healthcare system factors contributing to delayed cochlear implantation in congenitally deaf children.
- To analyze the impact of newborn hearing screening (NBHS) and insurance type on CI timing.
- To pinpoint specific system-level and parental factors causing delays.
Main Methods:
- Retrospective chart review and parental interviews were conducted.
- Data from 59 congenitally deaf children who received CIs between 2002 and 2009 were analyzed.
- Factors influencing age at implantation were statistically evaluated.
Main Results:
- Children with mandatory newborn hearing screening (NBHS) and specific insurance types were more likely to receive timely cochlear implants (CIs).
- Lack of NBHS, NBHS failing to detect hearing loss, Medicaid insurance, and reliance on non-implant center providers were associated with delayed implantation.
- Slow referrals and parental factors were identified as key reasons for delays.
Conclusions:
- Implementing targeted interventions for at-risk children is necessary.
- Ensuring universal NBHS and educating parents and primary care providers about early intervention are critical.
- Streamlining referrals to implant centers can reduce delays in CI access for deaf children.
Objective:
Identify social and health care system factors that prevent congenitally deaf children from receiving cochlear implants (CIs) in a timely fashion.
Study Design:
Retrospective chart review and parental interviews.
Setting:
University medical center hospital in a state with mandatory newborn hearing screening (NBHS).
Patients:
Fifty-nine congenitally deaf children who received CIs between January 1, 2002, and May 1, 2009.
Interventions:
Demographic and health care details were collected from the 59 patients.
Main Outcome Measure:
Age at implantation.
Results:
Thirty-four patients received implants at or before age 2 years (average age at implant surgery, 14 mo), and 25 patients received implants after age 2 years (average age, 65 mo). The presence of NBHS (p<0.001) and type of health insurance (p=0.05) the child had at the time of CI surgery were significant predictors of age at implantation. The following factors were associated with increased risk of delayed implantation: no NBHS (risk ratio [RR]=2.63), NBHS not identifying hearing loss (RR=1.63), Medicaid insurance alone (RR=1.21) or in combination with private insurance (RR=1.79), family physician as primary care provider (RR=1.50), and audiologist (RR = 1.30) or otolaryngologist (RR=1.31) as secondary care providers (versus implant center, RR=0.23). The main reasons for delay in CI surgery after age 2 years also were identified and include slow referrals for care (n=8) and parental delays (n=5).
Conclusion:
The data suggest placing special focus on children with associated risk factors, ensuring NBHS, and parent and primary care provider education on the importance of early intervention and referral to an implant center would likely limit delays in children receiving CIs.
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