Ethnic differences in etiologies and audiological outcomes of cochlear implantation in Israeli children

To examine differences in hearing loss etiologies and cochlear implant outcomes between Jewish and Arab pediatric populations in Israel, addressing the understudied influence of ethnic disparities.

A retrospective cohort study was conducted on 120 children (53 Jewish, 67 Arab) who underwent 171 cochlear implantations at our hospital between May 2018 and December 2022. Data included demographics, socioeconomic status, etiology, and audiological outcomes. Outcomes were assessed using pure tone averages (PTA) and speech thresholds (SRT/SDT) at seven-time points over 60 months. Predictors of early and long-term outcomes were evaluated using multivariate ANCOVA models.

Jewish and Arab children had comparable demographics, but significant socioeconomic differences (399.5 ± 378.7 vs. 110.3 ± 181.6, p < 0.0001). Hearing loss etiologies differed significantly: Arab children showed predominantly congenital causes (68.7%), mainly genetic (62.7%), while Jewish children had higher acquired causes (54.7%), primarily CMV-related (52.5%). PTA thresholds were significantly better in Jewish patients at 1-4, 25-36, and 49-60 months post-implantation (p < 0.05). SRT/SDT thresholds did not differ. Multivariate analysis identified ethnicity, younger age at surgery, primary implantation status, and etiology as significant predictors of outcomes. Socioeconomic rank was not independently associated with outcomes.

Ethnic differences in cochlear implant outcomes persist despite Israel's universal healthcare system, reflecting the impact of unmeasured social, cultural, and behavioral factors. These findings underscore the importance of individualized treatment strategies that consider both biological and sociocultural factors to optimize outcomes for all populations.