Disparities in Speech and Language Delay Among Children With Aural Atresia

Abstract

Objective: To describe risk factors for speech and language delay in a diverse population of children with aural atresia. Methods: Retrospective chart review was performed from 2012 to 2020 at UCSF Benioff Children’s Hospital to identify children with aural atresia evaluated for speech, language, or auditory skills delays. Ninety-five children with aural atresia, conductive hearing loss, and assessment of speech, language, or auditory skills delay were included. Demographic and clinical data were analyzed to identify predictors of speech and language delay. Cohort and case-control analyses were performed to determine risk factors for delayed intervention, and for ultimate delays in speech, language, or auditory skills. Results: Children exhibited a wide diversity of race/ethnicity, primary home language, geography, and insurance status. Eighty-nine percent had unilateral aural atresia. Forty-eight percent had delays in speech, language, or auditory skills. Most children used hearing aids (84%), had educational accommodations (84%), and received speech therapy (63%). In a univariate retrospective cohort analysis, public-insured (p = 0.004), non-English speaking (p = 0.002) and non-white/non-Hispanic children (p = 0.007) were found to be significantly less likely to be fit with hearing aids in infancy. Children with delays were fit with hearing aids at later ages. In a multivariate case-control analysis, primary home language was a significant predictor for presence of delays [OR, 3.9 (95% CI: 1.2–13.2), p = 0.03]. Conclusions: Disparities due to insurance type, primary language, and race/ethnicity are associated with delays in hearing aid fitting for children with aural atresia. Earlier, hearing amplification is correlated with reduced risk for speech, language, and auditory skills delay. These findings can help identify at-risk children for targeted support.

Use of Socioeconomic Demographic Data in Studies on Pediatric Unilateral Hearing Loss: A Scoping Review

“…Furthermore, among the states that cover the cost of hearing aids, there is often a reimbursement cap ranging from $800 every 36 months to $1510 every year, depending on the state patients live in (Medicaid Benefits: Hearing Aids and Other Hearing Devices 2019). Thus, families with Although we focused on a few select demographic variables in our scoping review, the literature demonstrates a variety of factors that contribute to disparities in children with hearing loss accessing the hearing healthcare they need: race/ethnicity, family income, parental education, insurance type, living environment, distance to nearest health center, recruitment techniques, health literacy, and more (Boss et al 2011;Bush et al 2014Bush et al , 2017Florentine et al 2022). If the appropriate healthcare and educational services are not accessed in a timely fashion, hearing loss can negatively impact children's language development, psychosocial relationships, academic performance, and career prospects.…”