Cochlear implantation in different socioeconomic groups - bursting the myth

Distance and Socieoeconomic Status as Barriers to Cochlear Implantation

OBJECTIVE

To assess the distance burden for access to cochlear implant (CI)-related services and to assess whether socioeconomic disadvantage or level of education and occupation influenced uptake of CIs.

STUDY DESIGN

Retrospective case review.

SETTING

A CI services provider operating across multiple centers.

PATIENTS

All patients undergoing CI surgery in a 2-year period between March 2018 and February 2020.

INTERVENTIONS

Diagnosis of hearing loss, CI surgery, and subsequent habilitation and mapping.

MAIN OUTCOME MEASURES

Distance traveled by patients to their audiological diagnostic, CI surgery hospital, and habilitation sites; subjects' index of relative socioeconomic advantage and disadvantage (IRSAD) and index of education and occupation (IEO).

RESULTS

n = 201 children and n = 623 adults. There was a significant difference across IRSAD domains for children (p < 0.0001) and adults (p < 0.0001), and IEO in children (p = 0.015) and adults (p < 0.0001) when tested for equal proportions. The median driving distance from home to the diagnostic audiological site for children was 20 km (mean, 69 km; range, 1-1184 km; upper quartile, 79 km; lower quartile, 8 km). There was no significant difference between the driving distances from home to the CI surgery hospital site, or the mapping/habilitation sites between children and adults. There was no correlation for age at first surgery and either IRSAD/IEO.

CONCLUSIONS

The burden of distance for access to CI in Australia is significant for the upper quartile who may not live within the large city centers. Greater consideration needs to be given regarding barriers to CI for those in lower socioeconomic and educational groups to ensure equity of access across different socioeconomic and educational level backgrounds.

Performance of a Closed Set Picture Identification Test in Tamil for Children with Cochlear Implant

The study attempted to assess the closed set word identification abilities in children with cochlear implant (CI) with a picture identification test developed in Tamil. The test was validated on typically developing children with normal hearing (NH) to build a reference for comparison. Participants for the study included 205 children with NH between the age range of 3-6 years and 45 children with cochlear implant within the age range of 3-11 years. The picture identification test was developed using bisyllabic words with corresponding pictures in Tamil. Two lists were created with 25 words each and administered to the children with NH and CI. The scores of both the groups were analysed. The results indicated that the mean scores improved as age increased for children in the NH group. Also, there was no significant difference in performance between the two-word lists. Significant difference in scores was noted between the CI and the NH group (p < 0.01). However, the mean scores in the CI group increased as the experience with CI increased. The picture identification test in Tamil is deemed appropriate to elicit closed set word identification responses for children with CI between the age of 3-6 years. The test will provide supplemental information for mapping and to plan habilitation for children with CI.

Sociodemographic Disparities in Pediatric Cochlear Implantation Access and Use: A Systematic Review

OBJECTIVES

Pediatric cochlear implantation (CI) is a multistep process, which exposes a healthcare system's potential weaknesses in ability to deliver timely care to deaf children. The current systematic review aims to determine the sociodemographic disparities that predict pediatric CI access and use among CI candidates and recipients across the world. We hypothesize that sociodemographic factors independently influence CI access and use within a given country.

STUDY DESIGN

Systematic review.

METHODS

A qualitative systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted for studies investigating the association of sociodemographic factors such as race, income, or insurance status with measures of pediatric CI access, such as age at CI or CI rate.

RESULTS

Out of 807 unique abstracts initially retrieved, 39 papers were included in the final qualitative systematic review. Twenty-seven thousand seven hundred and fifty-one CI-candidate children (6,623 CI recipients) were studied in 14 countries, with 21 studies conducted in the United States of America, published within the years of 1993 to 2020.

CONCLUSION

Some measures of CI access, such as age at CI and rates of CI, are consistently reported in the CI disparities literature while others such as access to rehabilitation services, willingness to undergo CI, and daily CI use are rarely measured. There are persistently reported disparities in a few key measures of CI access in a few populations, while there are some populations with a paucity of data. Future studies should delineate the nuances in the mechanisms of disparities by conducting multivariable analysis of representative sample data. Laryngoscope, 2021.