Related Experiment Video
Updated: Mar 14, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Delays in Sound Recognition and Imitation in Underinsured Children Receiving Cochlear Implantation
McKenzie Tolan1, Andrea Serpas1, Katherine McElroy2
1Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC.
Insights
Children with cochlear implants who are publicly insured experience significant delays in achieving sound recognition and imitation proficiency compared to privately insured peers. This impacts auditory development despite similar pure-tone audiometry results.
Area of Science:
- Pediatric audiology and cochlear implantation outcomes.
- Health services research in pediatric healthcare access.
- Speech-language pathology and auditory development.
Background:
- Previous research identified barriers to early pediatric cochlear implantation in underinsured populations.
- The impact of delayed implantation on auditory and speech-language development remains unevaluated.
Purpose of the Study:
- To assess if health insurance status influences the achievement of basic sound access and imitation skills in pediatric cochlear implant recipients.
- To investigate the relationship between insurance status and auditory-linguistic developmental milestones.
Main Methods:
- Retrospective review of 123 children (1-12 years) who received cochlear implants.
- Analysis of auditory function, time to Ling-6 proficiency, therapy appointments, and educational setting.
- Comparison based on age, implantation details, and health care insurance status.
Main Results:
- Of 37 patients with Ling-6 scores, 62.1% achieved proficiency.
- Publicly insured recipients achieved Ling-6 proficiency 6 months later than privately insured recipients (11.0 vs 5.0 months).
- Health insurance status was an independent predictor of inadequate Ling-6 discrimination (OR 46.2).
Conclusions:
- Publicly insured children with cochlear implants show a critical delay in sound recognition and imitation proficiency.
- This delay occurs despite comparable post-implantation auditory function on pure-tone audiometry.
- Insurance status significantly impacts the attainment of fundamental auditory skills in pediatric cochlear implant users.
Importance:
Barriers to early pediatric cochlear implantation in underinsured populations have been previously reported. However, to our knowledge, the effect of this delay on the development of auditory and speech-language objectives has not been evaluated.
Objective:
To determine if health care insurance status affects the achievement of proficiency in basic sound access and imitation tasks in children with cochlear implants.
Design, Setting, And Participants:
A retrospective review of 123 children aged 1 to 12 years receiving cochlear implants at the single tertiary referral academic free-standing Children's National Health System in Washington, DC, between January 1, 2008, and December 31, 2015.
Main Outcomes And Measures:
Auditory function after cochlear implantation, time to proficiency in Ling-6 scores, and number of speech therapy and audiological appointments, as well as current educational setting, were compared with patient age at diagnosis of hearing loss, age at cochlear implantation, cochlear implantation insertion technique, and health care insurance status for recipients of cochlear implants.
Results:
A total of 123 children aged 1 to 12 years (mean [SD] age, 64.0 [57.4] years) with cochlear implants were included in the study. Of 37 patients with complete and accurate Ling-6 test scores, 23 (62.1%) were able to have proficiency a mean of 5.1 months at follow-up. Despite equal auditory performance on pure-tone audiometry after cochlear implantation, publicly insured recipients had Ling-6 proficiency a mean of 6.0 months (95% CI, 5.5-6.5 months) later than privately insured recipients (11.0 vs 5.0 months). When controlling for patient age, time to cochlear implantation, number of therapy sessions, and cochlear implantation insertion technique, multivariable logistic regression analysis revealed health care insurance status to be the independent variable associated with inadequate Ling-6 discrimination scores (odds ratio, 46.2; 95% CI, 2.9-729.4).
Conclusions And Relevance:
Despite equal speech detection scores, publicly insured recipients of cochlear implantation had a significant and critical delay in attaining proficiency in a fundamental measure of sound recognition and imitation.
