title: Timing discrepancies of early intervention hearing services in urban and rural cochlear implant recipients.
abstract: OBJECTIVE
  The purpose of this study was to examine the timing of early intervention diagnostic and therapeutic services in cochlear implant recipients from rural and urban areas.
  
  
  METHODS
  Retrospective case series review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Cochlear implant recipients from a single comprehensive hearing institute born with severe congenital sensorineural hearing loss were examined. Timing of diagnostic and therapeutic services was examined.
  
  
  METHODS
  Diagnosis, amplification, and eventual cochlear implantation for all patients in the study.
  
  
  METHODS
  Time points of definitive diagnosis, amplification, and cochlear implantation for children from urban and rural regions were examined. Correlation analysis of distance to testing center and timing of services was also assessed.
  
  
  RESULTS
  Forty children born with congenital hearing loss were included in the study and were diagnosed at a median age of 13 weeks after birth. Children from rural regions obtained amplification at a median age of 47.7 weeks after birth, whereas urban children were amplified at 26 weeks after birth. Cochlear implantation was performed at a median age of 182 weeks after birth in those from rural areas and at 104 weeks after birth in urban-dwelling patients. A linear relationship was identified between distance to the implant center and timing of hearing aid amplification (r = 0.5, p = 0.033) and cochlear implantation (r = 0.5, p = 0.016).
  
  
  CONCLUSIONS
  Children residing outside of metro areas may be at higher risk of delayed rehabilitative services and cochlear implantation than those residing in urban areas that may be closer to tertiary care centers.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington; †Heuser Hearing Institute, Louisville; and ‡University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
authors.forename: Mary
authors.initials: M
authors.lastname: Burton
authors.forename: Ashley
authors.initials: A
authors.lastname: Loan
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
mesh_terms: D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000151:congenital / Q000601:surgery*; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012424:Rural Population; D013997:Time Factors; D016896:Treatment Outcome; D014505:Urban Population