Factors Influencing Time to Cochlear Implantation

Objective:To determine demographic and audiologic factors associated with time to treatment with cochlear implantation.Methods:Retrospective review of a prospectively maintained adult cochlear implant database. A total of 492 patients were implanted from 2012 to 2017. Time to implantation, preimplantation audiologic outcomes, and demographic data were collected. Multivariate analysis was undertaken to establish demographic/audiologic factors that predict time to cochlear implantation.Results:Using multivariate analysis, nonwhite race (hazard ratio 0.157, p=0.038) and increased age (hazard ratio 0.970, p=0.038) were associated with increased time to cochlear implantation. Nonwhite patients had significantly higher pure-tone averages and lower speech recognition scores (consonant-nucleus-consonant words and AzBio sentences in quiet) and were less likely to use hearing aids as compared with white patients (all p<0.001). Sex (p=0.188), health insurance type (p=0.255), preoperative hearing aid use (p=0.174), and audiologic outcomes were not significant predictors of time to implantation.Conclusion:Nonwhite patients have poorer preoperative hearing and speech recognition and lower hearing aid use and are at risk for delay in referral and treatment for severe to profound sensorineural hearing loss. Other demographic factors, notably health insurance status, did not significantly predict time to cochlear implantation. Given the observed hearing healthcare disparities, special outreach programs may be needed to ensure timely cochlear implantation and effective hearing screening and rehabilitation.