Barriers to the early cochlear implantation of deaf children.

OBJECTIVE: Identify social and health care system factors that prevent congenitally deaf children from receiving cochlear implants (CIs) in a timely fashion. STUDY
DESIGN: Retrospective chart review and parental interviews.
SETTING: University medical center hospital in a state with mandatory newborn hearing screening (NBHS). PATIENTS: Fifty-nine congenitally deaf children who received CIs between January 1, 2002, and May 1, 2009.
INTERVENTIONS: Demographic and health care details were collected from the 59 patients. MAIN OUTCOME MEASURE: Age at implantation.
RESULTS: Thirty-four patients received implants at or before age 2 years (average age at implant surgery, 14 mo), and 25 patients received implants after age 2 years (average age, 65 mo). The presence of NBHS (p<0.001) and type of health insurance (p=0.05) the child had at the time of CI surgery were significant predictors of age at implantation. The following factors were associated with increased risk of delayed implantation: no NBHS (risk ratio [RR]=2.63), NBHS not identifying hearing loss (RR=1.63), Medicaid insurance alone (RR=1.21) or in combination with private insurance (RR=1.79), family physician as primary care provider (RR=1.50), and audiologist (RR = 1.30) or otolaryngologist (RR=1.31) as secondary care providers (versus implant center, RR=0.23). The main reasons for delay in CI surgery after age 2 years also were identified and include slow referrals for care (n=8) and parental delays (n=5).
CONCLUSION: The data suggest placing special focus on children with associated risk factors, ensuring NBHS, and parent and primary care provider education on the importance of early intervention and referral to an implant center would likely limit delays in children receiving CIs.