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首页> 外文期刊>Otology and neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology >Barriers to the Early Cochlear Implantation of Deaf Children
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Barriers to the Early Cochlear Implantation of Deaf Children

机译：早期人工耳蜗植入聋哑儿童的障碍

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摘要

Objective: Identify social and health care system factors that prevent congenitally deaf children from receiving cochlear implants (CIs) in a timely fashion. Study Design: Retrospective chart review and parental interviews. Setting: University medical center hospital in a state with mandatory newborn hearing screening (NBHS). Patients: Fifty-nine congenitally deaf children who received CIs between January 1, 2002, and May 1, 2009. Interventions: Demographic and health care details were collected from the 59 patients. Main Outcome Measure: Age at implantation. Results: Thirty-four patients received implants at or before age 2 years (average age at implant surgery, 14 mo), and 25 patients received implants after age 2 years (average age, 65 mo). The presence of NBHS (p < 0.001) and type of health insurance (p = 0.05) the child had at the time of CI surgery were significant predictors of age at implantation. The following factors were associated with increased risk of delayed implantation: no NBHS (risk ratio [RR] = 2.63), NBHS not identifying hearing loss (RR = 1.63), Medicaid insurance alone (RR = 1.21) or in combination with private insurance (RR = 1.79), family physician as primary care provider (RR = 1.50), and audiologist (RR = 1.30) or otolaryngologist (RR = 1.31) as secondary care providers (versus implant center, RR = 0.23). The main reasons for delay in CI surgery after age 2 years also were identified and include slow referrals for care (n = 8) and parental delays (n = 5). Conclusion: The data suggest placing special focus on children with associated risk factors, ensuring NBHS, and parent and primary care provider education on the importance of early intervention and referral to an implant center would likely limit delays. in children receiving CIs.
机译：目的：确定可预防先天聋哑儿童接受人工耳蜗（CIS）的社会和卫生保健系统因素。研究设计：回顾性图表审查和父母访谈。环境：具有强制性新​​生儿听力筛查（NBHS）的州大学医学中心医院。患者：在2002年1月1日至2009年5月1日之间接受CIS的五十九名先天性聋哑儿童。干预措施：从59例患者那里收集了人口统计和医疗保健细节。主要结果度量：植入时代。结果：34例患者在2岁（植入物手术的平均年龄为14个月）和25名患者2岁后接受植入（平均年龄为65 MO）。儿童在CI手术时患有NBHS（P <0.001）和健康保险类型（P = 0.05）是植入时年龄的重要预测指标。以下因素与延迟植入的风险增加有关：没有NBHS（风险比[RR] = 2.63），NBHS未识别听力损失（RR = 1.63），仅Medicaid保险（RR = 1.21）或与私人保险结合（ RR = 1.79），作为初级保健提供者（RR = 1.50）的家庭医生和听力学家（RR = 1.30）或耳鼻喉科医生（RR = 1.31）作为二级护理提供者（对植入中心，RR = 0.23）。还确定了2岁以后CI手术延迟的主要原因，并包括慢速的护理转诊（n = 8）和父母延迟（n = 5）。结论：数据表明，特别关注具有相关危险因素，确保NBH的儿童以及父母和初级保健提供者对早期干预和转诊至植入中心的重要性的教育可能会限制延迟。在接受顺式的孩子中。

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