title: Delays in diagnosis of congenital hearing loss in rural children.
abstract: OBJECTIVE
  To examine the incidence of pediatric congenital hearing loss and the timing of diagnosis in a rural region of hearing healthcare disparity.
  
  
  METHODS
  Data from the Kentucky newborn hearing-screening program was accessed to determine the incidence of congenital hearing loss in Kentucky, both in the extremely rural region of Appalachia and non-Appalachian region of Kentucky. We also performed a retrospective review of records of children with congenital hearing loss at our institution to determine the timing of diagnostic testing.
  
  
  RESULTS
  In Kentucky, during 2009-2011, there were 6970 newborns who failed hearing screening; the incidence of newborn hearing loss was 1.71 per 1000 births (1.28/1000 in Appalachia and 1.87/1000 in non-Appalachia); 23.8% of Appalachian newborns compared with 17.3% of non-Appalachian children failed to obtain follow-up diagnostic testing. Children from Appalachia were significantly delayed in obtaining a final diagnosis of hearing loss compared with children from non-Appalachian regions (P = .04).
  
  
  CONCLUSIONS
  Congenital hearing loss in children from rural regions with hearing healthcare disparities is a common problem, and these children are at risk for a delay in the timing of diagnosis, which has the potential to limit language and social development. It is important to further assess the causative factors and develop interventions that can address this hearing healthcare disparity issue.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Louisville, KY. Electronic address: matthew.bush@uky.edu.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bush
authors.affiliation: University of Kentucky College of Medicine, Lexington, KY.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bianchi
authors.affiliation: Cabinet for Health and Family Services Commission for Children with Special Health Care Needs, Louisville, KY.
authors.forename: Cathy
authors.initials: C
authors.lastname: Lester
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Louisville, KY.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Shinn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Louisville, KY.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gal
authors.affiliation: Department of Biostatistics, University of Kentucky, Lexington, KY.
authors.forename: David W
authors.initials: DW
authors.lastname: Fardo
authors.affiliation: Department of Behavioral Science, University of Kentucky, Lexington, KY.
authors.forename: Nancy
authors.initials: N
authors.lastname: Schoenberg
mesh_terms: D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000151:congenital / Q000175:diagnosis* / Q000453:epidemiology; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D015997:Neonatal Screening; D011379:Prognosis; D012189:Retrospective Studies; D012424:Rural Population
keywords: ABR; Auditory brainstem response; EDHI; Early detection of hearing loss and intervention