Determinants of Cochlear Implant Evaluation Completion and Uptake in Children

Background/Objectives: Approximately half of US children who meet traditional cochlear implant (CI) candidacy criteria receive an implant. As candidacy expands to include a broader range of hearing configurations, identifying factors that influence referral completion and CI uptake is increasingly important. This study examined the predictors of CI evaluation completion and surgery among children referred for CI assessment, including both traditional and non-traditional candidates. Methods: The medical records of pediatric patients referred for an initial CI evaluation from 2018 through 2024 were reviewed. Referral outcomes were categorized as evaluation not completed, candidate who declined surgery, or candidate who proceeded with surgery. Two binomial logistic regression models assessed the demographic, audiologic, and contextual predictors of CI evaluation completion and CI uptake, including age at referral, candidate type, insurance, referral year, communication mode, race/ethnicity, unaided thresholds, rurality, and county-level social health determinants. Results: The completion of the CI evaluation was significantly influenced by race/ethnicity, candidate type, referral year, and age. Mixed-race children demonstrated higher completion rates than White children. Completion was lower among children with single-sided deafness (SSD), children referred in 2022, and older children. Among children determined to be candidates, 69% proceeded with surgery. CI uptake showed similar patterns, with lower rates among Hispanic children, children with residual hearing or SSD, children referred in 2022, and older children. Conclusions: CI uptake at this center exceeded national averages but was associated with race/ethnicity, candidate type, age, and year of referral. Targeted counseling and outreach may improve timely referral and informed decision-making.