The impact of race and ethnicity on cochlear implant outcomes

Abstract

Objectives: Racial and ethnic disparities in healthcare access and outcomes are well documented, yet their influence on cochlear implant (CI) performance remains underexplored. This study evaluated whether race or ethnicity is associated with post-implant speech recognition outcomes.

Methods: A retrospective review was conducted of adult CI recipients at a single tertiary academic center (2012-2024). Demographic variables, including race, ethnicity, and sex, were analyzed alongside speech recognition outcomes: AzBio sentence, Consonant-Nucleus-Consonant (CNC) phoneme, and CNC word scores. Patients were grouped as White vs. non-White and Hispanic/Latino vs. non-Hispanic/Latino. Between-group differences were assessed using independent t-tests and Wilcoxon rank-sum tests. Multivariable linear regression models adjusted for age, sex, body mass index, tobacco and substance use, number of follow-ups, and duration of hearing loss.

Results: Among patients with complete data (n = 115 in total; n = 110 AzBio; n = 60 CNC), no significant differences were observed in post-implant speech recognition improvement between White and non-White patients for AzBio (p = 0.758), CNC phonemes (p = 0.228), or CNC words (p = 0.309). Additionally, there were no significant differences between Hispanic/Latino and non-Hispanic/Latino groups for AzBio (p = 0.653), CNC phonemes (p = 0.873), or CNC words (p = 0.751). Multivariable linear regression revealed no significant associations between race or ethnicity and any speech recognition outcome.

Conclusion: Race and ethnicity were not significantly associated with post-implant speech recognition outcomes. While this may indicate equitable CI performance across demographic groups, this study was limited by a smaller sample size and other possible unmeasured variables. Future studies should incorporate larger cohorts and more granular social determinants of health to better characterize potential disparities in post-implant performance.

Keywords: Audiologic outcomes; Cochlear implantation; Health disparities; Speech recognition outcomes.