Barriers to Receiving Necessary Hearing Care Among US Children

Abstract

Objective We aim to clarify the national scope of unmet pediatric hearing care needs and identify specific barriers to hearing care. Study Design Cross-sectional study of a nationally representative data set. Setting This study is based on the combined 2016 and 2017 National Survey of Children’s Health. This survey covers the physical and emotional health, access to care, and social context of US children and adolescents aged 0 to 17 years. Methods Analysis of parent-reported responses of children’s hearing status, access to care, and perceived barriers. Results Overall, 0.3% (n = 206,200) of US children surveyed reported needing hearing care, which was not received. A further 1.3% (n = 934,000) reported deafness or problems with hearing, and of these, 6.4% (n = 60,000) reported not receiving necessary hearing care. Rates of insurance coverage between children with deafness/hearing problems and the general population were similar (91.7% vs 93.9%); however, deaf or hard-of-hearing children with unmet hearing care needs were more likely to be from non-White backgrounds (P = .009) and to lack health insurance coverage (P = .001). Rates of unfulfilled hearing care by reason were as follows: 57.5% without eligibility for the service, 45.4% reporting the service was not available in their area, 53.7% with difficulty obtaining an appointment, and 53.5% reporting issues with cost. Conclusion Over 200,000 children annually do not receive necessary hearing-related care despite high rates of insurance coverage, and nearly 60,000 of these children are deaf or hard of hearing. Cost, eligibility for and distribution of services, and timely appointments are the primary barriers to hearing health care.

Inclusion and Deaf and Hard of Hearing Students: Finding Asylum in the LRE

“…Whether these services or settings have improved is difficult to monitor due to limited data on outcomes [39,40]. In addition to sometimes inappropriate or inadequate services, most DHH students-notably hard of hearing students-may not receive any services at all [41]. This is particularly true for rural DHH children [42] and for DHH children during the COVID pandemic [43].…”

Diversity, Equity, and Inclusion in Otolaryngology–Head and Neck Surgery: The Big Picture

“… Point 1 In HPV‐associated oropharyngeal squamous cell carcinoma (OPSCC), Black and nonprivately insured patients are less likely to receive primary surgery when compared with White or privately insured patients 1 Points 2 and 3 Deaf or hard‐of‐hearing children with unmet hearing care needs are more likely to be from non‐White backgrounds 2 Black patients undergo cochlear implant evaluation and cochlear implantation at rates disproportionately lower than expected based on local demographics.…”

“…Deaf or hard‐of‐hearing children with unmet hearing care needs are more likely to be from non‐White backgrounds 2 …”

Challenges in Achieving Health Equity and Diversity in Otolaryngology

“…4 Hearing-related services for children, a particularly vulnerable group, face multiple challenges and barriers in providing access to these much-needed services. 5 Disparities in otolaryngology care outcomes are also seen in rural communities, especially related to head and neck cancers. Several epidemiologic studies that investigated a variety of head and neck cancers revealed that rurality may affect access to specialized treatment protocols or result in delayed diagnosis and more advanced disease.…”

“…The need for basic otolaryngology care is particularly evident in vulnerable and marginalized groups, such as the diverse urban homeless population in Vatican City, which includes individuals from over 60 countries 4 . Hearing‐related services for children, a particularly vulnerable group, face multiple challenges and barriers in providing access to these much‐needed services 5 . Disparities in otolaryngology care outcomes are also seen in rural communities, especially related to head and neck cancers.…”