Barriers to early pediatric cochlear implantation

Armstrong, Michael F.; Maresh, Alison; Buxton, Claire; Craun, Patricia; Wowroski, Lauren; Reilly, Brian J.; Preciado, Diego

doi:10.1016/j.ijporl.2013.08.031

Cited by 66 publications

(119 citation statements)

References 9 publications

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“…21,22 Children are at a higher risk of being non-adherent with recommended testing and delayed in treatment of hearing loss if their mothers have a low socioeconomic status and are covered by public insurance. 23,24 Lester and colleagues 25 reported that children with severe sensori neural hearing loss with Medicaid are at a 21% higher risk of being delayed in receiving a cochlear implant compared to those with private insurance. There is an obvious relationship between low socioeconomic status and the likelihood of being on public insurance.…”

Section: Discussionmentioning

confidence: 99%

Rural Barriers to Early Diagnosis and Treatment of Infant Hearing Loss in Appalachia

Bush

Hardin

Rayle

et al. 2015

Otology &Amp; Neurotology

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Objective The purpose of this study is to assess regional parental barriers in the diagnostic and therapeutic process following abnormal newborn hearing screening (NHS) testing. Study Design Cross-sectional questionnaire study Setting Tertiary medical center Patients Parents of infants who failed NHS in Kentucky from January 2009 – February 2012 Main Outcome Measure Demographic information, county of origin, and attitudes and perceptions regarding NHS and barriers in the NHS diagnostic process. Results There were 460 participants in the study, which included25.4% of parents were from the Appalachian region. 21% of Appalachian parents found the process on newborn hearing testing difficult. Appalachian parents were more likely to have no more than 12 years of education (OR 1.7, p=0.02) and Medicaid insurance (OR 2.3, p<0.001) compared with non-Appalachian parents. A higher percentage of Appalachian parents were unaware of the NHS results at the time of hospital discharge than non-Appalachians (14% v. 7%, p=0.03). Distance from the diagnostic/therapeutic center represented was a significant barrier for Appalachian parents (OR 2.8, p=0.001). Compared with urban parents, a greater percentage of rural parents had never heard of a cochlear implant (p=0.01). Appalachian parents expressed a strong interest in telemedicine and a desire for closer services. Conclusion Multiple barriers including education, distance, accessibility, socioeconomic factors can affect timely diagnosis and treatment of congenital hearing loss for children residing in rural areas. Educational and telemedicine programs may benefit parents in Appalachia, as well as parents in other rural areas.

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Section: Discussionmentioning

confidence: 99%

Rural Barriers to Early Diagnosis and Treatment of Infant Hearing Loss in Appalachia

Bush

Hardin

Rayle

et al. 2015

Otology &Amp; Neurotology

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“…Fitzpatrick et al [21] found that progressive hearing loss and other medical conditions contributed to late CI. In another study, Armstrong et al [13] reported that having public insurance or no insurance and parental barriers were significantly associated with late CI. Here, parental barriers included missed/delayed appointments due to difficulties navigating the health care system, misunderstanding the candidacy process, non-compliance with candidacy evaluation appointments and hesitation regarding evaluations and surgery.…”

Section: Discussionmentioning

confidence: 97%

“…In our clinical experience, many congenitally deaf children do not undergo CI until they are 24 months or older. Gender discrimination, delayed diagnosis, medical comorbidities, parental misgivings and other socioeconomic factors are potential barriers to early implantation [13]. This study was designed to further explore the factors that impact early CI in Chinese children.…”

Section: Introductionmentioning

confidence: 99%

Factors impacting early cochlear implantation in Chinese children

Dai

et al. 2015

Eur Arch Otorhinolaryngol

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This study aimed to determine the factors that impact early cochlear implantation (CI) in Chinese children. The charts of 56 pediatric cochlear implant recipients were retrospectively reviewed. Parental interviews were conducted to collect information regarding the factors that potentially impact early CI in Chinese children. The mean age at CI was 40.98 months, and the median age was 24 months. Thirty patients received an implant before 24 months of age, and the other 26 patients received the implant after 24 months of age. By univariate logistic regression analysis, newborn hearing screening (NHS), financial burden impacted early CI significantly (p < 0.05), while the multivariate analysis indicated that only NHS significantly influenced the early CI (p < 0.05). The following factors were associated with a moderately increased risk of late implantation: lack of NHS [odds ratio (OR) = 5.833], living in a rural community (OR = 2.714), and communication barriers (OR = 2.691). Living in a rural community, financial burden and communication barriers negatively impact the age at CI, whereas NHS positively influence the age at CI. Increased awareness of these factors could promote early CI and improve the quality of life of congenitally deaf children.

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“…Early implantation during periods of optimal neural plasticity maximizes early auditory experience and leads to more ageappropriate speech and language skills [67,82,83], which may also increase the likelihood for mainstream education from earlier ages onwards. Likely contributing factors for this delay between diagnosis and implantation include funding constraints, lack of prompt referral to specialized CI services, parental barriers such as delayed/missed appointments, complex medical conditions, family indecision and geographical location [81,84,85].…”

Section: Discussionmentioning

confidence: 99%

Predictors of pediatric cochlear implantation outcomes in South Africa

Roux

Vinck

Butler

et al. 2016

International Journal of Pediatric Otorhinolaryngology

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Objective: To identify and describe predictors of pediatric cochlear implantation outcomes in a South African population. Methods:A retrospective study of 301 pediatric CI recipients from five cochlear implant programs was conducted and cross-sectional outcome data were added at the time of data collection. Twenty potential prognostic factors were identified from the retrospective dataset, including biographical, cochlear implant (CI), family and risk factors. Multiple regression analyses was performed to identify predictor variables that influence outcomes in terms of auditory performance (CAP scores), speech production (SIR scores), communication mode and educational placement.Results: Although implanted children within this sample did not have equal opportunity to access a second implant, bilateral implantation was strongly predictive of better auditory performance and speech production scores, an oral mode of communication and mainstream education. NICU admittance/ prematurity were associated with poorer auditory performance and speech production scores, together with a higher probability for non-oral communication and non-mainstream education. The presence of one or more additional developmental 2 condition was predictive of poorer outcomes in terms of speech production and educational placement, while a delay between diagnosis and implantation of more than one year was also related to non-mainstream education. Ethnicities other than Caucasian were predictive of poorer auditory performance scores and a lower probability for mainstream education.Conclusion: An extensive range of prognostic indicators were identified for pediatric CI outcomes in South Africa. These predictive factors of better and poorer outcomes should guide pediatric CI services to promote optimal outcomes and assist professionals in providing evidence-based informational counselling.

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Barriers to early pediatric cochlear implantation

Cited by 66 publications

References 9 publications

Rural Barriers to Early Diagnosis and Treatment of Infant Hearing Loss in Appalachia

Rural Barriers to Early Diagnosis and Treatment of Infant Hearing Loss in Appalachia

Factors impacting early cochlear implantation in Chinese children

Predictors of pediatric cochlear implantation outcomes in South Africa

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