(A955) Understanding Barriers to Timely Cochlear Implantation in the Pediatric Population

Introduction: While universal newborn hearing screening has increased early detection of hearing loss in children, social determinants of health may affect timely interventions such as cochlear implantation. This study aims to elucidate existing barriers in healthcare by investigating the relationship between social factors and early cochlear implantation in the pediatric population.

Methods: This is a retrospective review at a tertiary level children’s hospital of patients 0-18 years undergoing unilateral or bilateral cochlear implant (CI) from January 2015 to December 2020. The primary outcome is time from audiological qualification for cochlear implant (CI) to implantation. Secondary outcomes include patient demographics, distance from hospital, insurance status, and primary language of caretakers.

Results: Ninety-seven patients (53.6% male, median age 2.78 years, [IQR 1.28-5.73]) met inclusion criteria. The patient population identified as 81.4% White, 12.4% Black, 12.4% Latino, and 6.2% Asian. Most patients had public insurance (60.8%) and median distance from the hospital was 60.4 miles. White patients were more likely to receive CI before age 2 compared to non-white patients (40.5% vs. 22.2%) but this was not significant (χ2=2.15, p=0.14). Patients with non-English-speaking parents experienced a shorter time between recommendation and cochlear implantation compared to patients with English-speaking parents (2.74 vs. 4.45 months, p< 0.05). Trends suggest that children with public vs. private insurance (4.89 vs. 3.11 months, p=0.07) and children who lived greater than 60 miles from the hospital (5.04 vs. 3.33 months, p=0.12) waited longer between CI recommendation and implantation.

Conclusions: Children with non-English speaking parents had less time between CI recommendation and CI. Trends indicate that patients whose caregivers use American Sign Language may have a shorter interval between CI recommendation and CI. While not statistically significant, the data suggest that race, insurance status, and distance to hospital may affect the timing between CI candidacy and implantation.