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Updated: Mar 17, 2026
Robotic Cochlear Implantation for Direct Cochlear Access
Published on: June 16, 2022
Access to and Uptake of Cochlear Implantation Among Children in North Carolina
Joni Alberg1, Matthew G Crowson2, Debara L Tucci3
1consultant, Yale Alberg & Associates; former executive director (1999-2014), BEGINNINGS, Raleigh, North Carolina.
Insights
Over 60% of North Carolina children with advanced hearing loss received cochlear implants (CI). Higher rates were observed for profound hearing loss, with no major financial or geographic barriers identified for CI access.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Public Health
Background:
- Cochlear implantation (CI) is a vital intervention for children with severe to profound hearing loss.
- Despite CI benefits, not all eligible children receive this treatment, necessitating research into access and barriers.
Purpose of the Study:
- To determine the percentage of North Carolina children who are candidates for and receive CI.
- To identify potential barriers preventing unimplanted candidates from accessing CI.
Main Methods:
- Retrospective analysis of 1,501 children served by BEGINNINGS (2009-2013).
- Contacted 141 potential CI candidate families to gather data on technology use and reasons for non-use.
Main Results:
- 60.9% of children with advanced hearing loss received at least one CI.
- Children with profound hearing loss had an 88.9% CI rate.
- Parental preference and unfavorable anatomy were key reasons for not pursuing CI.
Conclusions:
- Over 60% of North Carolina children with advanced hearing loss receive CI, with higher rates for more severe impairments.
- No significant financial or geographic barriers to CI were found.
- Parental access to counseling and education through BEGINNINGS may contribute to high CI rates.
Background:
Cochlear implantation (CI) is a highly effective intervention for children with advanced hearing loss who cannot benefit from amplification. Despite the established benefits of CI, it is likely that not all children who are potential candidates for CI receive this intervention. The purpose of this study was to determine the percentage of North Carolina children who are candidates for and end up undergoing CI, and to detect whether barriers exist that prevent access to care for unimplanted candidates.
Methods:
This study was a retrospective analysis of 1,501 children whose families were served by BEGINNINGS from January 1, 2009 through December 31, 2013. All families of children identified as potential CI candidates who were able to participate in the study (n = 141) were contacted by BEGINNINGS parent educators who queried parents about their child's use of technology and any reasons for lack of use of technology.
Results:
Overall, 60.9% of children diagnosed with profound, severe-profound, severe, moderate-severe, or moderate-profound hearing loss received at least 1 cochlear implant. For children with profound hearing loss, 88.9% had a least 1 cochlear implant. Common reasons for the decision not to perform CI included parental preference and anatomical issues unfavorable to CI.
Limitations:
Some information was not included in the database, including socioeconomic status and the child's age at the time of intervention.
Conclusion:
The rate of CI for North Carolina children who have advanced hearing loss is greater than 60% and significantly higher for children with greater degrees of impairment. No significant financial or geographic barriers to CI were identified. We hypothesize that the high rate of CI for appropriate candidates in North Carolina is due in part to parental access to counseling and education provided through BEGINNINGS.
