By Lisa Rapaport

(Reuters Health) – Even though American veterans are at high risk for the type of hearing loss that may be improved with cochlear implants, many of them live hours from a VA facility that provides cochlear implant services, a U.S. study suggests.

Cochlear implants are the best treatment available for moderate to severe sensorineural hearing loss – the type of permanent hearing loss that can be caused by aging and by exposure to loud noises that many veterans may experience in combat. When people have sensorineural hearing loss, high pitched noises can be muffled and they may struggle to decipher spoken words when there is a lot of noise in the background.

For the study, researchers examined how close 19.9 million veterans lived to a VA facility offering cochlear implant services including audiologists to evaluate the extent of hearing loss with or without implants.

Overall, half of these veterans lived at least 80 miles away from a VA facility providing cochlear implant care, the study found. And almost 4 million of them lived more than 160 miles away from these hearing services.

“There are a large number of veterans who likely find it impossible to get to the specialized clinics able to fit them with cochlear implants,” said Dr. Tim Hullar, senior author of the study and director of the cochlear implant program at Oregon Health and Science University and the Portland VA Medical Center.

“The most striking finding to me was the number of medium and even very large cities in the US where no VA center performs cochlear implants,” Hullar said by email.

When researchers looked at facilities with comprehensive cochlear implant care – including both surgical and audiologic services – half of the veterans in the study lived at least 101 miles away and 20% of them had to travel more than 201 miles.

Veterans living in urban areas fared better than their rural counterparts, but some of them still faced long trips for cochlear implant services.

Roughly 74% of veterans in the study lived in urban areas. Half of these urban veterans lived 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 lived more than 206 miles away from the nearest facility.

The researchers looked only at the distance between veterans’ homes and VA facilities, and 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, the study team notes in JAMA Otolaryngology-Head & Neck Surgery.

“While full coverage for cochlear implantation may be provided by the Veterans Health Administration, thus eliminating the potential `insurance issue’ of coverage for cochlear implantation, large distances to travel each requiring repeated 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 involved in the study.

Travel barriers might mean some veterans with hearing loss who aren’t helped 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, intelligible sound amplification for the purposes of speech recognition,” Bhattacharyya added. “In this situation, cochlear implants have been found to be very helpful in rehabilitating hearing and particularly speech recognition in more severe to profound cases of hearing loss.”

SOURCE: JAMA Otolaryngology-Head & Neck Surgery, online August 1, 2019.