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Original Investigation
January 2017

Delays in Sound Recognition and Imitation in Underinsured Children Receiving Cochlear Implantation

Author Affiliations
  • 1Division of Pediatric Otolaryngology, Children’s National Health System, Washington, DC
  • 2Division of Hearing and Speech, Children’s National Health System, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2017;143(1):60-64. doi:10.1001/jamaoto.2016.2730
Key Points

Question  Does insurance status affect time to proficiency in Ling-6 scores after cochlear implantation?

Findings  In this medical record review, despite equal auditory testing after cochlear implantation, publicly insured children had Ling-6 proficiency a mean of 6 months later than privately insured children.

Meaning  We have shown a correlation between patient health care insurance status and the achievement of proficiency in sound access and imitation tasks in our publicly insured cochlear implant population. These data suggest that certain populations may be at risk for language delay after implantation and, therefore, may require increased speech and language support.


Importance  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.

Objective  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.

Main Outcomes and Measures  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.

Results  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).

Conclusions and Relevance  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.