title: Cochlear Implant Access in Six Developed Countries.
abstract: BACKGROUND
  Access to cochlear implantation varies greatly around the world. It is affected by factors that are specific to each country's health care system, by awareness, and by societal attitudes regarding deafness.
  
  
  METHODS
  Cochlear implant clinicians and researchers from six countries explored and discussed these variations and their likely causes: Robert Briggs from Australia; Wolfe-Dieter Baumgartner from Austria; Thomas Lenarz from Germany; Eva Koltharp from Sweden; Christopher Raine from the United Kingdom, and Craig Buchman, Donna Sorkin, and Christine Yoshinago from the United States.
  
  
  RESULTS
  Utilization rates are quite different for the pediatric and adult demographics in all six countries. Pediatric utilization ranges in the six countries (all in the developed world) ranged from a low of 50% in the United States to a high of 97% in Australia. Adult utilization is less than 10% everywhere in the world.
  
  
  CONCLUSIONS
  Pediatric access to care was excellent for children with the exception of Germany and the United States where there is an inadequate referral system. Adult utilization was low everywhere because of the lack of screening for adults and the fact that primary care physicians and even audiologists are unfamiliar with CI candidacy criteria and outcomes, and hence typically do not make patient referrals.
authors.affiliation: *American Cochlear Implant Alliance, McLean, Virginia †Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Sorkin
authors.forename: Craig A
authors.initials: CA
authors.lastname: Buchman
mesh_terms: D000328:Adult; D002648:Child; D019929:Cochlear Implantation; D003054:Cochlear Implants / Q000706:statistics & numerical data*; D003638:Deafness / Q000601:surgery; D003695:Delivery of Health Care; D019049:Developed Countries / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D013548:Sweden; D006113:United Kingdom; D014481:United States