title: Barriers to the early cochlear implantation of deaf children.
abstract: OBJECTIVE
  Identify social and health care system factors that prevent congenitally deaf children from receiving cochlear implants (CIs) in a timely fashion.
  
  
  METHODS
  Retrospective chart review and parental interviews.
  
  
  METHODS
  University medical center hospital in a state with mandatory newborn hearing screening (NBHS).
  
  
  METHODS
  Fifty-nine congenitally deaf children who received CIs between January 1, 2002, and May 1, 2009.
  
  
  METHODS
  Demographic and health care details were collected from the 59 patients.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Lester
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Dawson
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Gantz
authors.forename: Marlan R
authors.initials: MR
authors.lastname: Hansen
mesh_terms: D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D057210:Delayed Diagnosis; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000151:congenital / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D007407:Interviews as Topic; D008297:Male; D015997:Neonatal Screening; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome