Trials with re-routing devices, such as a contralateral-routing-of-signal system or a bone conduction device, are not recommended for children seeking binaural hearing, “as these devices are not able to provide the brain with bilateral input, and the trial could delay a time-sensitive procedure,” noted the guidelines.
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August 2022Timing aside, one of the most powerful arguments favoring CI for SSD is the striking transformations that are often observed in treated patients. Dr. Park cited, as an example, a 13-year-old who visited the office two weeks after having her implant turned on. “She came in looking completely different,” Dr. Park said. “Her mom said she was just feeling so much more confident and so much less fatigued. She just feels better, relaxed, and has less anxiety now that she can hear from both ears.”
Nikki Kean is a freelance medical writer based in New Jersey.
Barriers to CI Implantation for SSD
Insurance coverage for cochlear implants (CI) for single-sided deafness (SSD) is “one of our biggest barriers right now,” said Lisa R. Park, AuD, a research assistant professor in the department of otolaryngology–head and neck surgery at the University of North Carolina at Chapel Hill. Some insurance plans are willing to cover only what the FDA recommends, which eliminates most of the congenital cases that occur at birth or within the first five years of life. “Some plans cover surgery without prior approval, while other plans state that it’s experimental and they don’t want to cover it,” she added.
A large portion of the population in rural communities only have Medicaid insurance, said Mathew Bush, MD, PhD, MBA, professor and vice chair for research in the department of otolaryngology– head and neck surgery at the University of Kentucky Medical Center in Lexington. “If they have to face large out-of-pocket expenses that they can’t afford, they aren’t likely to seek care.”
Rural communities also lack resources, facilitators, and healthcare access for children with SSD, added Dr. Bush. (Otol Neurotol. 2015;36:93-98) Indeed, there is a huge disparity between the number of hearing healthcare providers within rural communities and the number of hearing healthcare providers working in urban and suburban areas. “If there is a hearing healthcare provider within their community, many times it’s one who lacks the confidence or experience in managing children with hearing loss,” he noted. This means travel and expenses that may not be possible for the family.