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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Sound Opportunities: Factors That Impact Referral for Pediatric Cochlear Implant Evaluation
Lisa R Park1, Elizabeth Preston1, Hannah Eskridge1
1Department of Otolaryngology/Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.
Insights
Referral rates for pediatric cochlear implantation (CI) are high for traditional candidates but low for nontraditional ones. Sharing best practices can improve CI access for more children.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Medical Device Technology
Background:
- Cochlear implantation (CI) offers significant benefits for children with severe-to-profound hearing loss.
- Identifying all eligible candidates, including those with non-traditional profiles, is crucial for equitable access to CI services.
Purpose of the Study:
- To identify barriers and opportunities influencing referral for cochlear implantation in children.
- To analyze factors affecting CI referral rates among potential pediatric candidates.
Main Methods:
- A retrospective review of audiological and medical records for 869 potential pediatric CI candidates over five years.
- Binomial logistic regression analysis to determine predictors of CI referral.
Main Results:
- Children meeting traditional severe-to-profound bilateral hearing loss criteria were referred at high rates.
- Referral rates were lower for nontraditional candidates, influenced by race, age, insurance, hearing thresholds, and provider/family factors.
Conclusions:
- While traditional CI candidates are referred effectively, current referral practices need enhancement for nontraditional candidates.
- Disseminating information on pediatric cochlear implantation trends and criteria can increase referral rates for a broader range of children.
Objectives/Hypothesis:
To identify barriers to and opportunities for referral among children who could be considered for cochlear implantation.
Study Design:
Retrospective review.
Methods:
Audiological and medical records were reviewed on all children who had diagnostic or hearing aid care through a statewide healthcare system over 5-year span to identify children who met newly established clinical cochlear implant (CI) referral criteria. Data were collected for 869 potential CI candidates regarding demographic, socio-economic, audiological, medical, and family factors that may influence referral. A binomial logistic regression was completed to investigate the potential contributions of these predictors toward referral for a CI evaluation.
Results:
Children who met traditional candidacy criteria of severe-to-profound bilateral hearing loss were referred at very high rates, while nontraditional candidates were referred less frequently. Factors influencing referral included race, age, insurance source, hearing thresholds, audiologist, physician, and family request.
Conclusions:
Results suggest that bilateral traditional candidates are being referred at high percentages; however, current practices and trends in pediatric cochlear implantation should be shared with families and providers to increase referral rates for nontraditional candidates. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2904-E2910, 2021.
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