Predictors of Cochlear Implant Adoption in Urban Underserved Patient Population

Introduction: Cochlear implantation (CI) is an underutilized treatment for sensorineural hearing loss (SNHL). High cost, fragmented referral systems, and low patient awareness are notable barriers. Herein, we evaluated rates and predictors of CI adoption amongst audiometric CI candidates at an urban safety-net hospital.

Methods: This retrospective cohort study examined adults with post-lingual bilateral SNHL who presented for CI audiologic evaluation at Temple University Health System from January 2015 to December 2022. Demographics, audiologic data, and otologic and medical history were compared between audiometric candidates who proceeded with or deferred CI. Speech recognition was compared based on patients’ primary language.

Results: Eighty-eight (90.7%) of the 97 patients evaluated were audiometric candidates for implantation. Of those, the 42 (47.7%) who deferred CI were older (68.8 vs 59.1 years; p< 0.01) and generally non-English speakers (47.6% vs 17.4%, p< 0.01). Non-English speakers most commonly spoke Spanish (85.4%). Mean speech recognition threshold (SRT) and speech recognition score (SRS) did not differ significantly between adopters and deferrers. In multivariate analysis, patients who deferred CI were more likely to have public insurance (OR=4.79; 95% CI [1.60,16.2]; p< 0.01) and be primarily non-English speakers (OR=4.79; 95% CI [1.66,14.5]; p< 0.01). There was no difference in diabetes, coronary artery disease, and a composite comorbidity index represented by American Society of Anesthesiologists (ASA) score, but there was a higher likelihood of depression in CI adopters. (OR=0.25; 95% CI [0.07,0.81], p=0.02).

Conclusions: Our data suggest private insurance, depression, and primary English language were significant predictors of CI adoption amongst audiometric candidates. Of note, baseline hearing level did not significantly influence decisions to pursue CI. Further studies should compare multi-institution CI adoption rates to understand factors that influence patient decision-making. This may help build tailored systems to address unique barriers to hearing rehabilitation.