Bush Matthew L, Osetinsky Mariel, Shinn Jennifer B, Gal Thomas J, Ding Xiuhua, Fardo David W, Schoenberg Nancy
Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
Laryngoscope. 2014 Jul;124(7):1713-7. doi: 10.1002/lary.24588. Epub 2014 Feb 10.
OBJECTIVES/HYPOTHESIS: The purpose of this study was to examine the timing of diagnostic and therapeutic services in cochlear implant recipients from a rural Appalachian region with healthcare disparity.
Retrospective analysis.
Cochlear implant recipients from a tertiary referral center born with severe congenital sensorineural hearing loss were examined. Rural status and Appalachian status of their county of origin were recorded. A log-rank test was used to examine differences in the distributions of time to definitive diagnosis of hearing loss, initial amplification fitting, and cochlear implantation in these children. Correlation analysis of the rural status of each county and the timing of services was assessed.
A total of 53 children born with congenital hearing loss were included in the study (36 from rural counties and 17 from urban/suburban counties). The distribution of weeks after birth to diagnosis (P=.006), amplification (P=.030), and cochlear implantation (P=.002) was delayed in rural children compared with urban children. An analysis factoring in the effect of implementation of mandatory infant hearing screening in 2000 demonstrated a similar delay in rural children for weeks to diagnosis (P=.028), amplification (P=.087), and cochlear implantation (P<.0001).
Children with severe hearing loss in very rural areas, such as Appalachia, may have significant delays in diagnostic and rehabilitative services. Further investigation is warranted to assess causative factors in delays of cochlear implantation and to develop interventions to promote timely diagnosis and care.
3b.
目的/假设：本研究旨在调查来自医疗保健存在差异的阿巴拉契亚农村地区的人工耳蜗植入受者的诊断和治疗服务时机。
回顾性分析。
对一家三级转诊中心出生时患有严重先天性感音神经性听力损失的人工耳蜗植入受者进行检查。记录其原籍县的农村和阿巴拉契亚地区状况。采用对数秩检验来检查这些儿童在听力损失确诊时间、初次助听器适配时间和人工耳蜗植入时间分布上的差异。评估每个县的农村状况与服务时机之间的相关性分析。
本研究共纳入53名先天性听力损失患儿（36名来自农村县，17名来自城市/郊区县）。与城市儿童相比，农村儿童在出生后至诊断（P = 0.006）、助听器适配（P = 0.030）和人工耳蜗植入（P = 0.002）的周数分布上有所延迟。一项考虑了2000年实施强制性婴儿听力筛查影响的分析表明，农村儿童在诊断（P = 0.028）、助听器适配（P = 0.087）和人工耳蜗植入（P < 0.0001）的周数上也有类似延迟。
在阿巴拉契亚等非常偏远农村地区患有严重听力损失的儿童，在诊断和康复服务方面可能会有显著延迟。有必要进一步调查以评估人工耳蜗植入延迟的致病因素，并制定促进及时诊断和护理的干预措施。
3b
