In Reply We are grateful to have the opportunity to respond to the letter by Cambron et al. With their help, we analyzed an updated 2019 data set using the same techniques we had previously applied to information from 2017 for use in our study.1
As Cambron et al point out and our data show, the opening of new cochlear implant centers in the interim has allowed veterans in major metropolitan areas such as Indianapolis, Las Vegas, New Orleans, and San Diego, and smaller urban centers such as Eugene, Oregon and Reno, Nevada to gain significantly better access particularly to centers providing audiologic services (Figure). Ongoing apparent disparities elsewhere may paradoxically reflect superior levels of care: outcomes are likely to be better at high-volume centers, which naturally require larger catchment areas. For example, veterans in Arizona are on average distant from care, but the alternative—developing a patchwork of small centers spread throughout the state—would dilute the pool of experienced and highly specialized cochlear implant clinicians.
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Shayman CS, Ha Y, Hullar TE. Cochlear Implant Access for Veterans—Reply. JAMA Otolaryngol Head Neck Surg. 2020;146(4):387–388. doi:10.1001/jamaoto.2019.4792
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