Disparities among different countries in access for diagnosis and treatment of pediatric sensorineural hearing loss

Objective: Timely diagnosis and management of pediatric sensorineural hearing loss (SNHL) is essential for best outcomes. This study evaluated the differences of health access among cochlear implant (CI) centers of countries with different health care systems. Study Design: Retrospective. Setting: Multicenter, tertiary pediatric CI referral center in four different countries: United States (USA), France (FR), Australia (AUS), and Brazil (BR). Patients: Pediatric (age 0-21 years (0-16 years AUS)) patients receiving CI between January 2017 and December 2019. Intervention(s): CI. Main Outcome Measure(s): Primary outcome measures included age at milestones in CI process and age at implantation. Results: There were 1,673 patients who underwent CI surgery at four multinational designated institutions were identified (n = 143 AUS; 153 BRA; 1,158 FR; and 219 USA). Median age at time of hearing loss diagnosis (p < 0.0001), median age at hearing aid (HA) fitting (p < 0.0001), and CI evaluation (p < 0.0001) differed between countries. However, age at CI surgery was not significantly different between countries. Time from diagnosis to HA fitting was impacted by country (p < 0.0001) and language (p = 0.01) but not by private compared with public insurance. There were 512 children with available data regarding onset of hearing loss as prelingual n = 358 (70%) and postlingual n = 154 (30%). In patients with prelingual severe to profound hearing loss, country and race/ethnic origin affected age at diagnosis (p < 0.0001, p = 0.001), HA fitting (p < 0.0001, p < 0.001), candidacy evaluation (p = 0.0001, p = 0.02), and CI surgery (p = 0.0027, p = 0.001). Conclusions: Age at pediatric CI was comparable across the CI centers compared in the four countries. This is encouraging given the effect of neuroplasticity on pediatric CI outcomes, despite different health care expenditures and delivery systems in the four countries. Improvement in care access for certain populations may decrease disparities in pediatric CI access worldwide.