Assessing Patient Barriers to Cochlear Implantation

Abstract

Objective: Evaluate barriers that deter adult patients from following through with cochlear implantation. Study Design: Retrospective chart review and phone survey. Setting: Single tertiary referral center. Patients: Between January 2019 and August 2021, 113 patients, without a previous cochlear implant (CI), were determined to be candidates for cochlear implantation. Thirty-eight (33.6%) patients deferred cochlear implantation. Survey response rate was 61.1% (22/36). Intervention: None. Main Outcome Measures: Demographic, socioeconomic, otologic history, and comorbidity factors associated with deferment of cochlear implantation. Patient survey assessment of factors that had the greatest impact, rated on a scale of 1 to 10 (10 being the most impactful), on their decision to defer a CI. Results: Out of the 113 patients who met inclusion criteria, 75 (66.3%) underwent cochlear implantation and 38 (33.6%) patients deferred. Comparing implanted versus deferred groups, there was no statistical difference in age (67.1 y versus 68.5 y; p = 0.690) or male sex (53.3% versus 57.9%; p = 0.692). The deferred group had higher mean neighborhood disadvantage state decile (5.3 versus 4.3; p = 0.064) and national percentile (73.0 versus 66.2; p = 0.106) scores, although neither were statistically significant. A greater proportion of the deferred group were not living independently at time of CI evaluation (13.2 versus 2.7%; p = 0.017). Fear of losing residual hearing was rated the highest among the survey respondents (mean rating of 5.1), followed by general medical health (4.9) and cost and financial concerns (3.6). Conclusion:The greatest concern among the patients was the fear of losing residual hearing. Spending greater time educating patients about the success and failure rates of cochlear implantation may reduce patient hesitancy with implantation.

Socioeconomic Status Among Cochlear Implant Candidates and Association With Surgical Pursuance

“…The proportion of individuals in our population who were cochlear implant candidates (91.9%) and who underwent surgery (89.9%) are higher than many others in the literature (rates of nonqualification ≤37% and rates of surgical deferral ≤38%) . This may be due to unmeasured differences in the demographics of our patient population—including race and ethnicity (which were not collected in our study), employment, and prior hearing aid use, all of which affect rates of cochlear implant qualification and surgical pursuance—or differences in our center’s threshold for cochlear implant evaluation referral .…”

“…The proportion of individuals in our population who were cochlear implant candidates (91.9%) and who underwent surgery (89.9%) are higher than many others in the literature (rates of nonqualification ≤37% and rates of surgical deferral ≤38%). 11,13,40,[44][45][46][47][48][49] This may be due to unmeasured differences in the demographics of our patient population-including race and ethnicity (which were not collected in our study), employment, and prior hearing aid use, all of which affect rates of cochlear implant qualification and surgical pursuance-or differences in our center's threshold for cochlear implant evaluation referral. 11,13 The median candidacy AzBio in quiet score among our entire evaluated cohort was lower than among other populations in the literature with higher nonqualification and surgical deferral rates; for example, in one study with an 18% surgical deferral rate, 40 the mean candidacy AzBio in quiet score among those who pursued surgery was 23.3%.…”

Investigating Deferral Rates in Cochlear Implantation: How Often Do Candidates Defer and Why?

“…Mangan et al (14) looked at patients out of the St. Louis, Missouri, and Little Rock, Arkansas, who deferred cochlear implantation and why they did so. Their study found a deferral rate of 33.6%, which is nearly double our rate of 16.2%.…”

Why Do Cochlear Implant Candidates Defer Surgery? A Retrospective Case–Control Study

“…2 Once patients have undergone CI evaluation and qualify for surgery, as many as 20%-50% ultimately decide against implantation, further limiting implantation rates. [6][7][8] This study aimed to gain insight on patients at risk of deferring CI surgery in the context of socioeconomic factors. We found that age, race, and marital status were critical factors in predicting surgery after being deemed CI candidates.…”

“…2,4,5 Furthermore, once patients qualify for implantation, up to 20%-50% ultimately elect against surgery. [6][7][8] This occurs despite mounting evidence linking hearing loss to cognitive decline and dementia, social isolation and depression, decreased employability, and increased risk of falls and hospitalizations. [9][10][11] The economic impact of hearing loss in the US is significant, with excess medical costs ranging between $3.3-12.8 billion.…”