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Otolaryngology, ENT & Sinus News Provided by the California Sinus CentersLack of Financial Barriers to Pediatric Cochlear Implantation: Impact of Socioeconomic Status on Access and Outcomes [Original Article]July 1, 2010, 12:00 pm by Archives of Otolaryngology Head & Neck SurgeryObjectives (1) To analyze if socioeconomic status influences access to cochlear implantation in an environment with adequate Medicaid reimbursement. (2) To determine the impact of socioeconomic status on outcomes after unilateral cochlear implantation. Design Retrospective cohort study. Setting University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital (tertiary referral center), Cleveland, Ohio. Participants Pediatric patients (age range, newborn to 18 years) who received unilateral cochlear implantation during the period 1996 to 2008. Main Outcome Measures Access to cochlear implantation after referral to a cochlear implant center, postoperative complications, compliance with follow-up appointments, and access to sequential bilateral cochlear implantation. Results A total of 133 pediatric patients were included in this study; 64 were Medicaid-insured patients and 69 were privately insured patients. There was no statistical difference in the odds of initial cochlear implantation, age at referral, or age at implantation between the 2 groups. The odds of prelingual Medicaid-insured patients receiving sequential bilateral cochlear implantation was less than half that of the privately insured group (odds ratio [OR], 0.43; P = .03). The odds of complications in Medicaid-insured children were almost 5-fold greater than the odds for privately insured children (OR, 4.6; P = .03). There were 10 complications in 51 Medicaid-insured patients (19.6%) as opposed to 3 in 61 privately insured patients (4.9%). Medicaid-insured patients missed substantially more follow-up appointments overall (35% vs 23%) and more consecutive visits (1.9 vs 1.1) compared with privately insured patients. Conclusions In an environment with adequate Medicaid reimbursement, eligible children have equal access to cochlear implantation, regardless of socioeconomic background. However, lower socioeconomic background is associated with higher rates of postoperative complications, worse follow-up compliance, and lower rates of sequential bilateral implantation, observed herein in Medicaid-insured patients. These findings present opportunities for cochlear implant centers to create programs to address such downstream disparities.
More from Archives of Otolaryngology Head & Neck Surgery Long-term Health-Related Quality of Life in Survivors of Head and Neck Cancer [Original Article] Archives of Otolaryngology Head & Neck Surgery: January 16, 2012, 12:00 pm Objective To examine health-related quality of life (HRQOL) reported by 5-year head and neck cancer survivors and factors that predicted these long-term scores. Design Prospective, observational outcomes study. Setting Tertiary care institution. Patients A total Sequential Bilateral Cochlear Implantation in Children: Quality of Life [Original Article] Archives of Otolaryngology Head & Neck Surgery: January 16, 2012, 12:00 pm Objective To assess the effect of sequential bilateral cochlear implantation in children on their quality of life (QoL). Design Prospective cohort-control study. Setting Tertiary academic referral center. Patients Thirty children with prelingual deafness underwent sequential Disinfection of Flexible Fiberoptic Laryngoscopes After In Vitro Contamination With Staphylococcus aureus and Candida albicans [Original Article] Archives of Otolaryngology Head & Neck Surgery: January 16, 2012, 12:00 pm Objective To determine the efficacy of various cleaning and disinfective methods in reducing bacterial and fungal load on flexible fiberoptic laryngoscopes (FFLs). Design In vitro model. Subjects Flexible fiberoptic laryngoscopes contaminated with Staphylococcus aureus Winter scene, Pittsburgh, Pennsylvania [About the Cover] Archives of Otolaryngology Head & Neck Surgery: January 1, 2012, 12:00 pm About This Journal [About This Journal] Archives of Otolaryngology Head & Neck Surgery: January 1, 2012, 12:00 pm
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