Objective-The purpose of this study is to compare the timing and impact of hearing healthcare of rural and urban adults with severe hearing loss who use cochlear implants (CI).Study Design-Cross-sectional questionnaire study Setting-Tertiary referral center Patients-Adult cochlear implant recipients.Main Outcome Measures-Data collected included county of residence, socioeconomic information, impact of hearing loss on education/employment, and timing of hearing loss treatment. The benefits obtained from cochlear implantation were also evaluated.
Rural children are often delayed in receipt of CI rehabilitation services. Multiple barriers including low SES, insurance type, and parental education can affect utilization of these services and may impact the recipient language development. Close follow-up and efforts to expand access to care are needed to maximize CI benefit.
Objective The objective of this study was to compare the timing of hearing aid (HA) acquisition between adult in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients. Study Design Cross-sectional questionnaire survey Methods We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI). Results The time to HA acquisition was greater for rural participants compared to urban participants (19.1 versus 25.7 years, p=0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (ρ=−0.54, p<0.001). Rural HA participants experienced longer commutes to hearing specialists (68 versus 32 minutes, p<0.001), were less likely to achieve a degree beyond high school (p<0.001), and were more likely to possess Medicaid coverage (p=0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants. Conclusions Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations. Level of Evidence 4
There is underutilization of cochlear implants with delays in implantation linked to distance from implant centers. Telemedicine could connect cochlear implant specialists with patients in rural locations. We piloted telemedicine cochlear implant testing in a small study, largely composed of normal-hearing volunteers to trial this new application of teleaudiology technology. Thirteen subjects (8 with normal hearing and 5 with hearing loss ranging from mild to profound) underwent a traditional cochlear implant evaluation in person and then via telemedicine technology. Routine audiometry, word recognition testing, and Arizona Biological Test (AzBio) and consonant-nucleus-consonant (CNC) testing were performed. Mean (SD) percent difference in AzBio between in-person and remote testing was 1.7% (2.06%). Pure tone average (PTA), speech reception threshold (SRT), and word recognition were similar between methods. CNC testing showed a mean (SD) difference of 6.8% (10.2%) between methods. Testing conditions were acceptable to audiologists and subjects. Further study to validate this method in cochlear implant candidates and a larger population is warranted.
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