March 13-15, 2016 • San Diego, CA


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Barriers and Outcomes of Cochlear Implantation Rehabilitation in Rural Appalachia

OBJECTIVE: The purpose of this study was to assess the rehabilitation barriers and outcomes for rural families of children with cochlear implants (CI) compared with urban families. STUDY DESIGN: Cross-sectional questionnaire study. SETTING: Tertiary medical center. PATIENTS: Parents of children who received cochlear implant(s) at University of Kentucky from October 1996 to June 2013. MAIN OUTCOME MEASURE: Demographic information including rurality, attitudes and perceptions regarding CI use, barriers to use, and Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) RESULTS: There were 34 participants in the study with implant recipient age ranging from 2-18y. 41% of parents were from the Appalachian region, with a mean Beale rural code of 6.75. The 2 groups were similar in parental level of education, mean family income, and insurance type. Appalachian participants were more likely to report distance to hearing specialists (p=0.032) and travel cost (p=0.011) as major barriers to rehabilitation. 73% of participants identified the Audiologist as the most helpful resource in dealing with CI issues. Children with reported difficulty in wearing their CI had significantly lower PEACH scores (p=.014). A linear regression model with an R-squared of 0.587 was used to analyze the factors involved in PEACH score outcomes and showed significant overall difficulty in the rehabilitative process was a negative predictor of PEACH score (p=.001, beta=-.483). The age of first CI was also a negative predictor of PEACH score (p=.002, beta=-.428). Consistent wearing of the implant at home was a positive predictor of PEACH score (p<.001, beta=.528). CONCLUSION: Multiple barriers, including distance to hearing specialists and overall perceived difficulty in the rehabilitation process, can affect communication development in pediatric CI recipients. Timing of implantation, but also consistency in CI use are meaningful predictors of speech outcomes. Further support and expanded access to care may assist families of pediatric implant recipients in rural regions achieve maximum benefit from implantation.

  • Describe barriers to optimal cochlear implant use faced by rural populations.
  • Discuss factors predicting speech performance outcomes in cochlear implant recipients in rural settings.

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Bryce Noblitt (Primary Presenter,POC), University of Kentucky Department of Otolaryngology, bryce.noblitt@uky.edu;
Bryce is a 4th year medical student at the University of Kentucky. He is the recipient of the Professional Student Mentored Research Fellowship, which has supported his research efforts in medical school. During his time there, he has been involved in a randomized clinical trial using a patient navigator to decrease patient follow-up time after failed newborn hearing screening. Recent research has been published in the Journal of Community Health. Bryce is currently applying for an Otolaryngology residency position for 2016.


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Matthew L. Bush, M.D. (Co-Presenter), University of Kentucky Dept. of Otolaryngology, matthew.bush@uky.edu;
Matthew L. Bush, M.D. is an Assistant Professor in the Department of Otolaryngology – Head and Neck Surgery. He earned his M.D. degree at Marshall University in Huntington, WV in 2003. He completed Otolaryngology residency at the University of Kentucky in 2008 followed by a post-doctoral research fellowship and Neurotology & Cranial Base Surgery fellowship at The Ohio State University (2008-2011). Board certified in Otolaryngology and Neurotology, Dr. Bush’s clinical practice focuses on disorders of hearing and balance, including pediatric cochlear implantation. This clinical practice blends well with Dr. Bush’s research interests, which are directed at assessing and addressing rural pediatric and adult hearing health disparities. A K23 Career Development Award from the NIH National Institute of Deafness and Communication Disorders and a Triological Society Career Development Award supports this research. Recent research has been published in The Journal of Pediatrics, Ear & Hearing, The Laryngoscope, and Otology & Neurotology.


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