Barriers to Rehabilitation Care in Pediatric Cochlear Implant Recipients

Objective: The purpose of this study was to assess barriers to rehabilitation care for pediatric cochlear implant (CI) recipients. Study Design: Cross-sectional questionnaire study. Setting: Tertiary medical center. Patients: Parents of children who received a CI from October 1996 to June 2013. Main Outcome Measure(s): Factors related to access to and barriers in audiology and speech therapy services, factors related to CI use, and performance with CI using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH). Results: Thirty-five parents participated in the study (21 rural residents and 14 urban residents). Distance was a significant barrier to audiology services for rural participants compared with urban participants (p = 0.01). Consistent CI use was complicated by mechanical complications or malfunction in 70% of rural children compared with 33% of urban children (p = 0.05). Only 10% of rural children were able to access speech therapy services at diagnosis compared with 42% of urban children (p = 0.04). Low socioeconomic (SES) status and Medicaid insurance were associated with a lack of local speech therapists and medical/mechanical CI complications. Higher parental educational attainment was associated with higher PEACH scores in quiet conditions compared with families with lower parental education (p = 0.04). Conclusions: Rural children are often delayed in receipt of CI rehabilitation services. Multiple barriers including low SES, insurance type, and parental education can affect utilization of these services and may impact the recipient language development. Close follow-up and efforts to expand access to care are needed to maximize CI benefit. Address correspondence and reprint requests to Matthew L. Bush, M.D., Ph.D., Department of Otolaryngology–Head and Neck Surgery, University of Kentucky Medical Center, 800 Rose Street, Suite C-236, Lexington, KY 40536-0293; E-mail: matthew.bush@uky.edu Presented at the CI2016 International Cochlear Implant Meeting, Toronto, Ontario, Canada, May 13, 2016. This work was supported by the National Institute of Deafness and Other Communication Disorders (1K23DC014074) (MLB). MLB is a consultant for MED-EL and Oticon Medical and receives research funding from Advanced Bionics. The authors have no other financial relationships or conflicts of interest to disclose pertaining to the manuscript. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2i6WMKr). Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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