A trek too far for an old soldier's cochlear implant care



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US veterans in need of cochlear implant (CI) care face daunting journeys to far-flung centres, with 20% of hearing-affected ex-military needing to travel over 200 miles (320km) for specialist appointments.

A recent study involving the Oregon Health and Science University (OHSU) carried out a statistical analysis of census tract–level data on 19.9 million US veterans, finding that "more than 80% of veterans in 7 states resided more than 180 miles from the nearest Veterans Health Administration facility providing cochlear implant services".

Many armed services veterans are at high risk for developing sensorineural hearing loss, making them candidates for CIs. But they cannot easily reach specialised surgical facilities, often located at large-volume hospitals, or the audiologists responsible for preoperative candidacy evaluations and postoperative programming and follow-up. Audiology appointments are typically required 3 or more times in the first postoperative year and then annually thereafter. Cochlear implant device programming, however, requires that a patient consult with an audiologist routinely in the first year after receiving the device, and annually thereafter.

The study authors, led by former OHSU specialist Corey S. Shayman, say the "large" geographic disparities in CI care access revealed by their work points to a need for "thoughtful placement of new facilities". They also add that, together with more careful placement of centre, "upcoming advances in remote programming of implants may help ensure appropriate care for this high-risk population."

Stats from the Hearing Health Foundation show that hearing health conditions occupy first and second place among veterans treated at US Department of Veterans Affairs (VA) medical centers. In 2017, these registered 1.79m disability compensation recipients for tinnitus, and 1.16m for hearing loss. At an average cost of $348.15 each, the VA buys an amazing one-in-five hearing aids sold every year in the USA, according to the most recent spending report (2010).

The authors of the OHSU study assumed that "the prevalence of severe to profound hearing loss among veterans was comparable to that of the general population, as has been previously reported in a cohort of veterans". They point out, however, that a different estimate was made by the Centers for Disease Control and Prevention, one suggesting that veterans are 30% more likely than nonveterans to have severe hearing impairment after adjustment for age and current occupation "Our analysis likely underestimates the true burden of hearing loss among veterans," the study reads.

Source: JAMA