October 2024

OTOLARYNGOLOGY

USE OF DIAGNOSTIC AUDIOLOGY AND COCHLEAR IMPLANTATION IN THE U.S.

Featuring: Kevin Y. Zhan, MD

A recent study published in JAMA Otolaryngology-Head & Neck Surgery and co-authored by Kevin Y. Zhan, MD, aimed to investigate the utilization of diagnostic audiology and cochlear implantation (CI) in the United States.

Cochlear implants are the recommended treatment for significant sensorineural hearing loss with poor speech understanding, but their utilization rates remain low in the U.S. This study sought to determine if CI utilization varied geographically within the U.S. and if there was a correlation between diagnostic audiology utilization and CI use.

​Using the PearlDiverMariner database, which contains claims data for 6.92 million patients with bilateral sensorineural hearing loss, the analysis focused on 804 three-digit ZIP code regions and merged the data with the U.S. Census American Community Survey to estimate socioeconomic status measures. They defined diagnostic audiology using specific procedural codes and measured CI use with claims data. The cumulative incidence of audiology or CI claims at five years after an initial sensorineural hearing loss claim was used to define utilization.

Findings
The results showed that CI utilization:
  • Varied across the U.S., with some regions having higher utilization rates than others
  • Did not significantly correlate with age at diagnosis, audiology use or socioeconomic variables
  • Was higher in regions that had larger patient counts, lower rates of poverty, and lower rates of sensorineural hearing loss diagnosis compared to regions with lower utilization
  • Had a weak negative correlation with the diagnosis rate

Several southeastern states had no ZIP codes in the top quartile of CI utilization, and in many parts of the eastern U.S., audiology utilization was relatively higher than CI utilization. There was also a strong positive correlation between audiology utilization and sensorineural hearing loss diagnosis rate.

Takeaways
The findings suggest under-referral and poor awareness are major contributors to low CI utilization, even in areas with higher rates of sensorineural hearing loss and audiology utilization.

The study highlights:
  • The need for better awareness among clinicians and patients about cochlear implants
  • The importance of further investigation into low referral rates in regions with high audiology utilization but low CI utilization
Kevin Y. Zhan, MD, Assistant Professor of Otolaryngology at Northwestern Medicine

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