Investigating Socioeconomic Barriers to Cochlear Implantation

Greiner, Rachel C.; Rubinstein, Jay T.; Kohlberg, Gavriel D.

doi:10.1097/mao.0000000000003985

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…It is noted that while our data suggested that not having English as a first language did not significantly impact the discussion of cochlear implants, it did correlate with reduced referral rates. This is consistent with a study from the USA which revealed that non-English speaking patients received fewer referrals compared to English-speaking patients [ 19 ]. This may suggest difficulties in adequately explaining cochlear implantation as an option or cultural differences in approaching hearing loss treatment.…”

Section: Discussionsupporting

confidence: 92%

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Swords,

Ghedia,

Blanchford

et al. 2024

PLoS Med

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Background Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.

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Section: Discussionsupporting

confidence: 92%

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Swords,

Ghedia,

Blanchford

et al. 2024

PLoS Med

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Cochlear implantation compliance among minorities at high risk for hearing impairment following universal newborn hearing screening

Ziv,

Danovitch,

Kaplan

et al. 2023

Eur Arch Otorhinolaryngol

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Use of Speech-to-Text Translation Resources to Address Communication Barriers in Patients With Hearing Loss: A Systematic Review

Ferraro,

Samaha,

Tannan

et al. 2024

Otol Neurotol

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Objective Patients with concomitant limited English proficiency (LEP) and hearing loss may experience communication barriers, not fully mitigated by traditional interpreter services. Although there is no clear consensus on the most reliable and optimal resources for these patients, speech-to-text (STT) applications with translation capability may bridge these barriers. We review the existing literature applying STT translation programs in clinical settings and identify commercially available STT translation resources to evaluate their prospective application in the otology setting. Databases Reviewed PubMed MEDLINE, Embase, and Web of Science. Methods A systematic review of English language peer-reviewed literature was conducted, examining STT translation in clinical settings. An additional search identifying STT software with translation capabilities was completed. Results Seven out of 591 unique citations met the inclusion criteria, and 29 unique STT translation applications were identified, supporting up to 140 languages. Stakeholders endorse positive perceptions of STT translation programs. Facilitators to implementation included time and cost feasibility, whereas barriers included risk of mistranslation and inability to assess accuracy. Ongoing machine-learning efforts are underway for developing and improving STT translation technologies, but there is paucity of literature evaluating their application in patients with hearing loss. Conclusions Small studies have suggested an acceptable level of accuracy for STT translation programs as adjunctive to standard of care services. Further work should proactively address implementation challenges with special attention to use of these technologies for patients with concomitant LEP and HL, while supporting additional technological advancement for application of these technologies in otology practice.

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Investigating Socioeconomic Barriers to Cochlear Implantation

Cited by 4 publications

References 21 publications

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults

Cochlear implantation compliance among minorities at high risk for hearing impairment following universal newborn hearing screening

Use of Speech-to-Text Translation Resources to Address Communication Barriers in Patients With Hearing Loss: A Systematic Review

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