Racial and Ethnic Disparities Among Hearing Aid and Cochlear Implant Patients at a Tertiary-Level Academic Otology Practice.

OBJECTIVE: Utilization of hearing aids (HAs) and cochlear implants (CIs) is limited, with our group previously demonstrating that non-White patients pursue CI less than White patients. The aim of this study was to compare the demographic makeup of patients more recently evaluated for both interventions in our clinic, exploring the influence of insurance on pursuit of HA, and whether changes have occurred in CI uptake. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary-level academic otology clinic. METHODS: All patients (18 yr or older) evaluated for an HA or CI in 2019 were included. Demographic variables (including race, insurance, and socioeconomic status) were compared between patients who did and did not obtain an HA or CI. RESULTS: In 2019, 390 patients underwent an HA evaluation, and 195 patients received a CI evaluation. Relative to patients evaluated for CI, patients evaluated for HA were more likely to be White (71.3% versus 79.4%, p = 0.027). Examining factors that affected HA purchase, Black race (odds ratio, 0.32; 95% confidence interval, 0.12-0.85; p = 0.022), and lower socioeconomic status (odds ratio, 0.99; 95% confidence interval, 0.98-1.00; p = 0.039) were associated with decreased odds. Demographic variables and AzBio quiet scores were not associated with decision to pursue CI surgery. CONCLUSIONS: White patients comprised a larger proportion of HA evaluations than CI evaluations. Furthermore, White patients and those of higher socioeconomic status were more likely to purchase HA. Improved outreach and expanded insurance benefits for HA are needed to ensure equal access to aural rehabilitation.

Audiometric and Patient-Reported Outcomes in Single-Sided Deafness Cochlear Implant Recipients Using the CIQOL-35.

OBJECTIVE: Describe the effect that cochlear implantation (CI) has on audiometric outcomes and quality of life (QOL) in patients with single-sided deafness (SSD). STUDY DESIGN: Retrospective case review. SETTING: Tertiary university hospital system. METHODS: Preoperative and postoperative AzBio performance and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile scores in CI patients with SSD were compared, and postoperative measures were compared to those from CI patients without SSD. RESULTS: Seventeen patients with unilateral CI and contralateral unaided pure-tone averages ≤30 dB were included. The median age was 60.2 (interquartile range [IQR], 50.9-64.9 years), and 7/17 (41%) were women. Median daily use was 8.2 hour (IQR, 5.4-11.9 h). The median preoperative AzBio quiet score in the ear to be implanted was 3% (IQR, 0%-6%). After a median follow-up of 12.0 months, the median postoperative AzBio quiet score was 76% (IQR, 47%-86%) (p < .01). SSD subjects demonstrated statistically significant improvements in median scores on the following CIQOL-35 subdomains following implantation: Entertainment (17 preoperatively vs 21 postoperatively), Listening Effort (12 vs 14), Social (17 vs 22), and Global (28 vs 35; p < .05). SSD patients achieved equal or higher postoperative CIQOL-35 scores in most subdomains (6/7) compared to an age-matched group of non-SSD CI recipients who underwent unilaterally (N = 19) or sequential (N = 6) implantation. CONCLUSION: SSD CI patients not only demonstrate significant improvements in speech perception testing in the implanted ear but also exhibit improvement in multiple QOL subdomains on the CIQOL-35, the only validated cochlear implant QOL instrument.

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program.

OBJECTIVE: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. METHODS: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. RESULTS: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). CONCLUSION: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.

Cochlear Implantation in Patients With Neurofibromatosis Type 2.

OBJECTIVE: To describe cochlear implantation (CI) outcomes in patients with neurofibromatosis type 2 (NF2). STUDY DESIGN: Retrospective case series. SETTING: A multidisciplinary NF2 clinic at a university hospital. PATIENTS/INTERVENTIONS: Patients with NF2 who underwent CI. MAIN OUTCOME MEASURES: Pre- and postimplantation audiometric data, including pure-tone average (PTA) and AzBio Sentence scores. RESULTS: Eight patients with NF2 underwent CI. The mean age at implantation was 28.6 years (range: 17-63 yr) and six were female. The average length of deafness before CI was 3.5 years (range: 0.3-10 yr). Two patients underwent previous microsurgical resection via middle fossa craniotomy and one patient was treated with stereotactic radiotherapy before CI. Two tumors were growing at the time of CI, five tumors were not growing for an average period of 3.8 years (range: 1-6 yr), and one tumor had undergone previous gross total resection. Mean preoperative unaided PTA was 103.1 dB (range: 81.3-115 dB) and all preoperative AzBio scores were 0% in the ear to be implanted. These improved to a mean postoperative PTA of 30.9 dB (range: 12.5-43.8 dB) and mean postoperative AzBio score of 20% (range: 0-82%) with an average follow-up length of 16.6 months (range: 1.4-27.6 mo). Data logging demonstrated that six patients were daily CI users and two were nonusers, one of whom had normal hearing in the contralateral ear. CONCLUSIONS: CI is an effective option for rehabilitating hearing loss in patients with NF2; however, patients with normal contralateral hearing or poor follow-up do not perform as well.