Challenges of Getting Otology Care in Socioeconomically Impacted Areas

For people living in socioeconomically depressed or rural locations, obtaining specialty healthcare like otology can be difficult for a variety of reasons.

The main challenge is lack of resources, including human resources, healthcare infrastructure, and health services, because otology services are mainly concentrated in metropolitan areas, said Ana H. Kim, MD, director of the Cochlear Implant Program and associate director of the residency program and an associate professor of otolaryngology–head and neck surgery at Columbia University Medical Center in New York City. Socioeconomically challenged patients may lack an understanding of ear diseases or may not know to see a specialist for certain ear issues. They may also have different cultural or religious beliefs, social support, and language barriers that may prevent them from gaining access to appropriate medical care.

Some otology care, such as a cochlear implant program, is available only at academic institutions due to the high cost of establishing and sustaining such services, said Dr. Kim. This requires a multidisciplinary team approach. For instance, a child with hearing loss, whether fitted with a hearing aid or undergoing cochlear implantation, requires continued access to service providers such as a speech therapist, educator, and social worker.

In addition, people living in isolated areas are more likely to lack the transportation that would allow them to access otology care and give them the ability to go to multiple or ongoing appointments. They might also lack the resources and internet access that would enable telehealth visits, said Matthew L. Bush, MD, PhD, MBA, chair of rural health policy, vice chair for research, and associate professor in the department of otolaryngology–head and neck surgery at the University of Kentucky Medical Center in Lexington.

Catherine Palmer, PhD, director of audiology and hearing aids in the department of otolaryngology and department of communication science and disorders at the University of Pittsburgh (UP) and the UP Medical Center, pointed out that amplification devices require regular maintenance and periodic repair. This can be burdensome for someone who doesn’t live close to a clinic. Some regions may have audiologists and otologists who travel there on a monthly or quarterly schedule, but that’s still problematic if a device has stopped working and the next visit isn’t for several months.

Challenges Mount

In addition to access issues, people in socioeconomically depressed and rural communities face other challenges in getting otology care. With a high percentage of unemployment, low incomes, and disability, these community members are more likely to rely on public insurance options. Unfortunately, studies have shown that public health insurance recipients, specifically those on Medicaid, have a higher risk of not scheduling or completing follow-up recommendations (Am J Audiol. 2009;18:24-33). This may occur due to the cost of having multiple appointments, as well as confusion regarding decision making around hearing loss, said Allison McGrath, AuD, CCC-A, clinical audiologist and assistant of otolaryngology, division of audiology, department of otolaryngology–head and neck surgery at Johns Hopkins Medicine in Baltimore.