Barriers to Pediatric Osseointegrated Bone-Conduction Hearing Devices

Authors

Maria B. Koenigs, Department of Otolaryngology, Children's National Hospital George Washington University School of Medicine and Health Sciences Department of Hearing and Speech, Children's National Hospital Department of Surgery, Children's National Hospital, Washington DC.
Hengameh K. Behzadpour
Chloe B. Harrington
Leslie Prado
Daniel Gorelik
Karen Woolman
Md Sohel Rana
Diego A. Preciado
Brian K. Reilly

Document Type

Journal Article

Publication Date

3-8-2022

Journal

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

DOI

10.1097/MAO.0000000000003534

Abstract

OBJECTIVE: To identify social, demographic, and clinical barriers for implantation with Osseointegrated Bone Conduction Devices (OBCD) in pediatric candidates. STUDY DESIGN: Retrospective cohort study of 94 children who met standard OBCD implantation criteria. SETTING: Tertiary stand-alone children's hospital. MATERIALS AND METHODS: Retrospective chart review comparing demographic (age, race, state of residence, and insurance) and clinical (severity and etiology of hearing loss, medical comorbidities, and early intervention) factors impacting implantation. Members of the existing cohort were then contacted to obtain a better understanding of qualitative factors impacting surgical decision. RESULTS: Of the identified 94 surgical candidates, 47 (50%) underwent OBCD implantation. State of residence significantly impacted implantation rates, with children from the District of Columbia and Virginia being less likely to receive an implant than those from Maryland. Private insurance, race, and ethnicity did not impact rate of implantation (OR 2.8 [95% CI 0.78-10]; 1.34 [95% CI 0.44-3.68]; and 1.0 [95% CI 0.42-2.43], respectively). Children with anotia or microtia and children younger than 10 years old were less likely to have an implant (OR 10.6 (95% CI 1.74-65). Thirty-nine children participated in the qualitative portion. Themes that emerged as reasons to forgo implantation included a child's young age, planned reconstruction for microtia or atresia, and overall device functionality and usage. Thirty-seven children (39%) of the cohort declined surgery and currently wear a nonsurgical bone conduction aid regularly. CONCLUSION: Despite known benefits of implantation, only one-half of children who were candidates underwent OBCD. Unlike cochlear implantation, where insurance status is a major risk factor for implantation delay and underperformance, for OBCD, implantation barriers appear to be more multifactorial and include medical, demographic, and social factors.

APA Citation

Koenigs, Maria B.; Behzadpour, Hengameh K.; Harrington, Chloe B.; Prado, Leslie; Gorelik, Daniel; Woolman, Karen; Rana, Md Sohel; Preciado, Diego A.; and Reilly, Brian K., "Barriers to Pediatric Osseointegrated Bone-Conduction Hearing Devices" (2022). GW Authored Works. Paper 619.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/619

Department

Pediatrics