Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC.
Division of Hearing and Speech, Children's National Health System, Washington, DC.
JAMA Otolaryngol Head Neck Surg. 2017 Jan 1;143(1):60-64. doi: 10.1001/jamaoto.2016.2730.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
先前已有报道称，在保险覆盖不足的人群中，早期儿科人工耳蜗植入存在障碍。但是，据我们所知，这种延迟对儿童听觉和言语语言目标发展的影响尚未得到评估。
确定医疗保健保险状况是否会影响植入人工耳蜗的儿童在基本声音识别和模仿任务中达到熟练程度。
设计、地点和参与者：这是一项对 2008 年 1 月 1 日至 2015 年 12 月 31 日期间在华盛顿特区的单一三级转诊学术型独立儿童国家卫生系统接受人工耳蜗植入的 123 名 1 至 12 岁儿童进行的回顾性研究。
人工耳蜗植入后的听觉功能、Ling-6 评分达到熟练程度的时间以及言语治疗和听力预约的次数，以及当前的教育环境，与患者听力损失的诊断年龄、人工耳蜗植入的年龄、人工耳蜗植入的插入技术以及人工耳蜗植入者的医疗保健保险状况进行了比较。
共纳入 123 名 1 至 12 岁（平均[标准差]年龄 64.0[57.4]岁）接受人工耳蜗植入的儿童。在 37 名完成和准确的 Ling-6 测试分数的患者中，有 23 名（62.1%）在随访时平均 5.1 个月时达到熟练程度。尽管人工耳蜗植入后的纯音听阈测试结果相同，但公共保险的受助人达到 Ling-6 熟练程度的时间比私人保险的受助人晚 6 个月（11.0 个月比 5.0 个月）。在控制患者年龄、人工耳蜗植入时间、治疗次数和人工耳蜗植入插入技术后，多变量逻辑回归分析显示，医疗保险状况是与 Ling-6 辨别评分不足相关的独立变量（优势比 46.2；95%CI，2.9-729.4）。
尽管言语检测评分相同，但接受人工耳蜗植入的公共保险受助人在基本声音识别和模仿能力方面达到熟练程度的时间明显延迟，且存在严重滞后。
