Health Service Use in Children With Mild Bilateral and Unilateral Hearing Loss.

Abstract

Objectives: The number of children identified early with mild bilateral and unilateral hearing loss (MUHL) has increased over the past 3 decades due to population-based newborn hearing screening initiatives. Early identification involves additional hearing-related services for these children in the early years. Despite the growing number of children, little information exists regarding their use of health care services. We examined overall health care utilization for this population of children with hearing loss in a Canadian pediatric center as well as the factors associated with audiology and early intervention service utilization.

Design: As part of a longitudinal MUHL research program, we examined health care utilization in a population-based cohort of 182 children with MUHL who were identified in one Canadian pediatric center from 2014 to 2018 and followed up to 6 years. Audiologic characteristics were collected prospectively, and health care utilization data were collected retrospectively through administrative databases. Descriptive statistics were used to summarize health care encounters. We used negative binomial regression models to examine the relationship between several clinical factors including age of diagnosis, degree, and laterality (unilateral/mild bilateral) of hearing loss, use of hearing technology, developmental concerns, and services used in audiology and early intervention.

Results: The 182 children were diagnosed at a median age of 4.1 months (interquartile range: 1.9, 55.7) and mean follow-up time was 48.6 (SD: 20.0) months. A total of 9867 hospital encounters were recorded in the medical chart including 2247 audiology, 3429 early intervention, and 701 Ear Nose and Throat service encounters. For audiology services, health care utilization (rate of visits per month of follow-up) was related to whether hearing loss was mild bilateral or unilateral, use of hearing aid(s), progressive hearing loss, developmental concerns, and age of diagnosis. Children with mild bilateral hearing loss had 68% more visits compared with children with unilateral hearing loss. Children with hearing aid(s) had 86%more visits than those without amplification. During the study period, 68.1% of children had at least one early intervention visit. In multivariable regression, after controlling for time followed, earlier age at diagnosis, bilateral hearing loss, use of hearing aid(s), progressive hearing loss, more severe hearing loss, and developmental concerns were all significantly associated with more early intervention service utilization.

Conclusions: Our findings provide a comprehensive profile of hearing-related services provided to a population-based cohort of early-identified children with MUHL. Children with mild bilateral loss required more audiology services than those with unilateral hearing loss. Two-thirds of the children with MUHL utilized some early intervention services. Use of hearing aid(s), bilateral hearing loss, progressive hearing loss, and earlier age of diagnosis result in more service utilization for both audiology and early intervention. Understanding the intensity of care use among various subgroups of children with hearing loss can shed light on the impact of these hearing losses and inform resource planning.