title: Delays in Sound Recognition and Imitation in Underinsured Children Receiving Cochlear Implantation.
abstract: Barriers to early pediatric cochlear implantation in underinsured populations have been previously reported. However, to our knowledge, the effect of this delay on the development of auditory and speech-language objectives has not been evaluated.
  
  
  
  To determine if health care insurance status affects the achievement of proficiency in basic sound access and imitation tasks in children with cochlear implants.
  
  
  
  A retrospective review of 123 children aged 1 to 12 years receiving cochlear implants at the single tertiary referral academic free-standing Children's National Health System in Washington, DC, between January 1, 2008, and December 31, 2015.
  
  
  
  Auditory function after cochlear implantation, time to proficiency in Ling-6 scores, and number of speech therapy and audiological appointments, as well as current educational setting, were compared with patient age at diagnosis of hearing loss, age at cochlear implantation, cochlear implantation insertion technique, and health care insurance status for recipients of cochlear implants.
  
  
  
  A total of 123 children aged 1 to 12 years (mean [SD] age, 64.0 [57.4] years) with cochlear implants were included in the study. Of 37 patients with complete and accurate Ling-6 test scores, 23 (62.1%) were able to have proficiency a mean of 5.1 months at follow-up. Despite equal auditory performance on pure-tone audiometry after cochlear implantation, publicly insured recipients had Ling-6 proficiency a mean of 6.0 months (95% CI, 5.5-6.5 months) later than privately insured recipients (11.0 vs 5.0 months). When controlling for patient age, time to cochlear implantation, number of therapy sessions, and cochlear implantation insertion technique, multivariable logistic regression analysis revealed health care insurance status to be the independent variable associated with inadequate Ling-6 discrimination scores (odds ratio, 46.2; 95% CI, 2.9-729.4).
  
  
  
  Despite equal speech detection scores, publicly insured recipients of cochlear implantation had a significant and critical delay in attaining proficiency in a fundamental measure of sound recognition and imitation.
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC.
authors.forename: McKenzie
authors.initials: M
authors.lastname: Tolan
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC.
authors.forename: Andrea
authors.initials: A
authors.lastname: Serpas
authors.affiliation: Division of Hearing and Speech, Children's National Health System, Washington, DC.
authors.forename: Katherine
authors.initials: K
authors.lastname: McElroy
authors.affiliation: Division of Hearing and Speech, Children's National Health System, Washington, DC.
authors.forename: Patricia
authors.initials: P
authors.lastname: Craun
authors.affiliation: Division of Hearing and Speech, Children's National Health System, Washington, DC.
authors.forename: Christine
authors.initials: C
authors.lastname: Williams
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Reilly
authors.affiliation: Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC.
authors.forename: Diego
authors.initials: D
authors.lastname: Preciado
mesh_terms: D001301:Audiometry, Pure-Tone / Q000379:methods; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000191:economics* / Q000639:trends; D003054:Cochlear Implants / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D003638:Deafness / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D054625:Healthcare Disparities; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007804:Language Development; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D013017:Sound Localization; D013067:Speech Perception; D013997:Time Factors; D014481:United States