Factors Associated With Parental Refusal of Pediatric Cochlear Implantation: A Retrospective Cohort Study
- 1Faculty of Medicine, University of British Columbia, Vancouver, Canada
- 2Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children’s Hospital, Vancouver, Canada
Abstract
Importance: Understanding why families decline cochlear implantation despite candidacy is critical for optimizing counseling and improving access to hearing rehabilitation. Objective: To identify clinical, demographic, and psychosocial factors associated with parental refusal of cochlear implantation among eligible pediatric candidates. Design: 9-year retrospective cohort study. Setting: Tertiary care pediatric referral center. Participants: Children aged 0 to 18 years with sensorineural hearing loss referred for cochlear implant evaluation in British Columbia, Canada. Exposures: Clinical, demographic, and psychosocial characteristics documented during the cochlear implant candidacy evaluation between April 2015 and May 2024. Main Outcome Measures: Parental refusal of cochlear implantation. Results: 343 referrals were included (50.4% female, median age 4 years, IQR 9). Of these, 205 patients were ultimately offered cochlear implantation (CI), 20 of whom declined (9.8%). Families who declined had a significantly higher age at the time of referral (11 years vs 2 years, P < .001), a longer duration of hearing loss (5 years vs 1 year, P = .01), and less family support (66.9% vs 25%, P = .015). A clearly documented preference for spoken communication and absence of family history of hearing loss was associated with lower odds of CI refusal (76% and 67% reduction respectively). CI ineligibility commonly resulted from prolonged auditory deprivation, adequate benefit from hearing aids, or absent or hypoplastic cochlear nerves. Among families declining implantation, commonly cited reasons included perceived adequate hearing with amplification, concerns regarding surgical risks, and uncertainty regarding expected functional benefit. Conclusions: Older age, increased duration of hearing loss, limited family support, and lower parental preference for spoken communication were associated with increased likelihood of cochlear implant refusal among eligible pediatric candidates. Relevance: Understanding factors associated with CI refusal may help clinicians tailor counseling and family-centered decision-making.
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BibTeX
@article{li2026factors,
title = {{Factors Associated With Parental Refusal of Pediatric Cochlear Implantation: A Retrospective Cohort Study}},
author = {Ying Jie Li and Fainess Mwakisimba BSc and Jayant Seth BSc and Frederick K. Kozak MD and Mark Felton MD and Amjad Tobia MD},
journal = {Journal of Otolaryngology - Head and Neck Surgery},
year = {2026},
month = oct,
doi = {10.1177/19160216261485554},
url = {https://doi.org/10.1177/19160216261485554},
note = {CC BY},
}
RIS
TY - JOUR
TI - Factors Associated With Parental Refusal of Pediatric Cochlear Implantation: A Retrospective Cohort Study
AU - Ying Jie Li
AU - Fainess Mwakisimba BSc
AU - Jayant Seth BSc
AU - Frederick K. Kozak MD
AU - Mark Felton MD
AU - Amjad Tobia MD
PY - 2026
DA - 2026/10/24
JO - Journal of Otolaryngology - Head and Neck Surgery
DO - 10.1177/19160216261485554
UR - https://doi.org/10.1177/19160216261485554
AB - Importance: Understanding why families decline cochlear implantation despite candidacy is critical for optimizing counseling and improving access to hearing rehabilitation. Objective: To identify clinical, demographic, and psychosocial factors associated with parental refusal of cochlear implantation among eligible pediatric candidates. Design: 9-year retrospective cohort study. Setting: Tertiary care pediatric referral center. Participants: Children aged 0 to 18 years with sensorineural hearing loss referred for cochlear implant evaluation in British Columbia, Canada. Exposures: Clinical, demographic, and psychosocial characteristics documented during the cochlear implant candidacy evaluation between April 2015 and May 2024. Main Outcome Measures: Parental refusal of cochlear implantation. Results: 343 referrals were included (50.4% female, median age 4 years, IQR 9). Of these, 205 patients were ultimately offered cochlear implantation (CI), 20 of whom declined (9.8%). Families who declined had a significantly higher age at the time of referral (11 years vs 2 years, P < .001), a longer duration of hearing loss (5 years vs 1 year, P = .01), and less family support (66.9% vs 25%, P = .015). A clearly documented preference for spoken communication and absence of family history of hearing loss was associated with lower odds of CI refusal (76% and 67% reduction respectively). CI ineligibility commonly resulted from prolonged auditory deprivation, adequate benefit from hearing aids, or absent or hypoplastic cochlear nerves. Among families declining implantation, commonly cited reasons included perceived adequate hearing with amplification, concerns regarding surgical risks, and uncertainty regarding expected functional benefit. Conclusions: Older age, increased duration of hearing loss, limited family support, and lower parental preference for spoken communication were associated with increased likelihood of cochlear implant refusal among eligible pediatric candidates. Relevance: Understanding factors associated with CI refusal may help clinicians tailor counseling and family-centered decision-making.
SN - 1916-0216
ER -