Identifying barriers and considerations for cochlear implantation in Amish children

Area of Science:

• Pediatric Otolaryngology
• Audiology
• Medical Sociology

Background:

• Cochlear implantation (CI) is a vital intervention for pediatric hearing loss.
• The Amish population presents unique cultural and social considerations that may impact healthcare access and adherence.

Purpose of the Study:

• To identify barriers to cochlear implantation (CI) for Amish children.
• To describe specific considerations for CI and otologic care within the Amish community.

Main Methods:

• A retrospective cohort study compared Amish children undergoing CI to an age-matched control group at a tertiary pediatric hospital (2008-2019).
• Demographics, hearing loss etiology, age at initial appointment and CI, appointment frequency (audiologic/otologic), and complications were analyzed.
• Social factors posing barriers to care were descriptively assessed.

Main Results:

• Eight Amish children received CI, with 75% undergoing newborn hearing screening and 38% having syndromic hearing loss.
• Amish patients had significantly fewer audiologic (15 vs. 33.5) and otologic (4.5 vs. 8.5) appointments compared to controls (p<.001, p=.028).
• Median age at implantation did not differ between groups (2.5 vs. 2.0 years). Transportation, communication, and battery charging limitations were identified social barriers.

Conclusions:

• Amish children undergoing CI encounter distinct barriers, such as transportation and technological limitations.
• These barriers contribute to a reduced frequency of hearing-related appointments compared to age-matched peers.
• Acknowledging and addressing these societal differences is essential for optimizing CI care for Amish children.