Breaking the deafening silence: “Addressing unacceptable delays in universal newborn hearing screening”

Aims: To analyze the duration from birth to cochlear implantation candidacy and the duration taken for cochlear implantation. To find the probable factors affecting the delay. Methodology: A prospective cohort study of cochlear implant candidates registered with Bilateral Profound Sensorineural Hearing Loss at the Sirimavo Bandaranayake Special Children’s Hospital, Peradeniya, Sri Lanka from 2018 to end of 2024. Data was collected from cochlear implant candidate database and phone interview of parents via structured questionnaire. Results: Patients registered for Cochlear Implantation from 2018 to 2024 were 191. Of these patients 87 completed the requirements for surgery of which 72 were confirmed to have completed Cochlear Implantation. 104 registered are awaiting surgery. A majority of children have taken between 1 to 2 years to be diagnosed and be registered as a candidate for the cochlear implantation program. The children registered within 12 months of birth, 27.70% had their cochlear implantation completed between 3 years to 4 years. In this ideal candidate category, the average age of child when Cochlear Implant done was 4 years. The main causes for the delay in diagnosis were the inadequacy of a universal hearing screening, the delay in timely referral of high-risk babies for hearing screening. The causes identified for the delay from the period of registration to the cochlear implantation, were delay in the availability of implants, in timely vaccinations, delay in transport and expenditure with the covid epidemic and the economic crisis in the recent past.Conclusion: A definite delay does exist in providing cochlear implantation as a treatment modality to children with congenital deafness in Sri Lanka. Implementation of Universal Hearing Screening would be the single most important solution for a better outcome. It is an achievable task recognized in the national Maternal Child Health program. It needs to be supported with sustainable financing to overcome key implementation challenge.