Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California.
Department of Psychological Sciences, University of California, Merced, Merced, California.
Pediatrics. 2022 Jun 1;149(6). doi: 10.1542/peds.2021-055459.
Infants with profound hearing loss are typically considered for cochlear implantation. Many insurance providers deny implantation to children with developmental impairments because they have limited potential to acquire verbal communication. We took advantage of differing insurance coverage restrictions to compare outcomes after cochlear implantation or continued hearing aid use.
Young children with deafness were identified prospectively from 2 different states, Texas and California, and followed longitudinally for an average of 2 years. Children in cohort 1 (n = 138) had normal cognition and adaptive behavior and underwent cochlear implantation. Children in cohorts 2 (n = 37) and 3 (n = 29) had low cognition and low adaptive behavior. Those in cohort 2 underwent cochlear implantation, whereas those in cohort 3 were treated with hearing aids.
Cohorts did not substantially differ in demographic characteristics. Using cohort 2 as the reference, children in cohort 1 showed more rapid gains in cognitive, adaptive function, language, and auditory skills (estimated coefficients, 0.166 to 0.403; P ≤ .001), whereas children in cohort 3 showed slower gains (-0.119 to -0.243; P ≤ .04). Children in cohort 3 also had greater increases in stress within the parent-child system (1.328; P = .02), whereas cohorts 1 and 2 were not different.
Cochlear implantation benefits children with deafness and developmental delays. This finding has health policy implications not only for private insurers but also for large, statewide, publicly administered programs. Cognitive and adaptive skills should not be used as a "litmus test" for pediatric cochlear implantation.
患有严重听力损失的婴儿通常被认为适合接受耳蜗植入。许多保险公司拒绝为有发育障碍的儿童植入耳蜗，因为他们获得言语交流的能力有限。我们利用不同的保险覆盖范围限制，比较了耳蜗植入或继续使用助听器后的结果。
我们从德克萨斯州和加利福尼亚州的 2 个不同州前瞻性地确定了患有耳聋的幼儿，并对他们进行了平均 2 年的纵向随访。队列 1（n=138）中的儿童认知和适应行为正常，接受了耳蜗植入。队列 2（n=37）和 3（n=29）中的儿童认知和适应行为较低。队列 2 中的儿童接受了耳蜗植入，而队列 3 中的儿童则接受了助听器治疗。
队列在人口统计学特征上没有显著差异。以队列 2 为参考，队列 1 中的儿童在认知、适应功能、语言和听觉技能方面的增益更快（估计系数为 0.166 至 0.403；P ≤.001），而队列 3 中的儿童的增益较慢（-0.119 至-0.243；P ≤.04）。队列 3 中的儿童的亲子系统内的压力也有较大的增加（1.328；P =.02），而队列 1 和 2 则没有差异。
耳蜗植入有益于患有耳聋和发育迟缓的儿童。这一发现不仅对私人保险公司，而且对大型全州性公共管理计划的健康政策都有影响。认知和适应能力不应作为小儿耳蜗植入的“试金石”。
