Hearing Rehabilitation in Veterans With Severe Hearing Loss: Challenges and Opportunities.
David R Friedmann, Andrew Nicholson, Nicholas Illenberger and 2 others
Among 213,285 Veterans with bilateral severe or worse hearing loss, only 2.9% received a cochlear implant over 10 years; 95.2% were managed with hearing aids.
Aided speech scores were unavailable, so it is unknown how many hearing-aid users were getting adequate benefit.
Key findings
1Among 213,285 Veterans with bilateral severe or worse hearing loss, the cumulative incidence of cochlear implant receipt was 1.9% at 5 years and 2.9% at 10 years, with death treated as a competing risk.
2Factors significantly associated with CI receipt included younger age, non-White race (lower likelihood), worse hearing loss severity, worse speech discrimination in the better ear, and later year of index audiogram. Neither rurality of residence nor whether the nearest VA facility offered CI programming or implantation was associated with receipt.
395.2% of the cohort were managed with hearing aids, 2.5% received a CI, and 2.3% had no evidence of hearing rehabilitation. Aided outcome scores were not available in the data.
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What it does not show
Aided speech recognition scores were not available in the data, so it is impossible to determine how many of the 95.2% managed with hearing aids were actually achieving functional communication benefit. The study is confined to the VA system and linked Medicare/Medicaid claims; care delivered through private insurers or other third-party payers was not captured. Bimodal configuration (CI in one ear plus a hearing aid in the other) could not be reliably distinguished from hearing-aid-only management. The duration of hearing loss before the index audiogram is unknown and may be longer than the observed window, meaning some Veterans may have waited even longer for a CI than the data show. Word recognition scores were missing for 12.9% of the better-ear values, potentially because hearing was too poor to test, which may bias the WRS variable. The study is observational and cannot establish causation between the identified factors and CI receipt; unmeasured provider-level and patient-preference factors may drive the observed patterns.
The easy way to misread this
Do not read the 95.2% hearing-aid rate as evidence that most Veterans are getting adequate communication benefit — the paper explicitly states that aided outcome scores were not available in the data, so it is unknown how many of those users are actually achieving functional speech recognition. The low CI rate (2.9% at 10 years) reflects a gap in care delivery, not a finding that hearing aids are working well for this population.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →