Cochlear Implantation

Even though American veterans are at high risk for the type of hearing loss that may be improve with cochlear implants; many of them live hours from a VA facility that provides cochlear implant services, a U.S. study suggests. Cochlear implantation are the best treatment available for moderate to severe sensorineural hearing loss the type of permanent hearing loss that can be cause by aging and by exposure to loud noises that many veterans may experience in combat.

When people have sensorineural hearing loss, high pitch noises can be muffle; so they may struggle to decipher spoken words when there is a lot of noise in the background. For the study, researchers examine how close 19.9 million veterans live to a VA facility offering cochlear implant services including audiologists to evaluate the extent of hearing loss with or without implants.

Cochlear implantation care

Overall, half of these veterans live at least 80 miles away from a VA facility providing cochlear implant care, the study find. And almost 4 million of them live more than 160 miles away from these hearing services.  When researchers look at facilities with comprehensive cochlear implant care; which including both surgical and audiologic services half of the veterans in the study live at least 101 miles away and 20% of them had to travel more than 201 miles.

Roughly 74% of veterans in the study live in urban areas. Half of these urban veterans live at least 61 miles away from the closest facility with cochlear implant care. And one if 5 of them had to travel at least 140 miles. The rest of the veterans lived in rural areas, and half of these veterans were at least 119 miles from a cochlear implant facility. One in 5 rural veterans live more than 206 miles away from the nearest facility.

The researchers look only at the distance between veterans’ homes and VA facilities; also they didn’t look at actual travel time. Distances less than 30 miles or 30 minutes away don’t usually pose significant barriers to care; but longer travel times or distances can make it harder for people to access treatment; so the study team notes in JAMA Otolaryngology Head & Neck Surgery.

Veterans with hearing loss

“While full coverage for cochlear implantation may be provide by the Veterans Health Administration; thus eliminating the potential `insurance issue’ of coverage for cochlear implantation; so large distances to travel each requiring repeat visits are yet another barrier to accessing care,” said Dr. Neil Bhattacharyya, a professor of otolaryngology at Harvard Medical School and Brigham and Women’s Hospital in Boston who wasn’t involve in the study.

Travel barriers might mean some veterans with hearing loss who aren’t help by hearing aids miss out on care that could help them, Bhattacharyya said by email. “Patients with severe hearing loss often reach a threshold of hearing loss beyond which hearing aids; which are the standard for treating mild to moderate forms of hearing loss; are not effective,” Bhattacharyya said.

“Once the hearing loss becomes “large enough”, even hearing aids cannot provide high enough quality; so intelligible sound amplification for the purposes of speech recognition,” Bhattacharyya added. “In this situation, cochlear implants have find to be very helpful in rehabilitating hearing and particularly speech recognition in more severe to profound cases of hearing loss.”