Dr. Vivian Kaul Delivers Grand Rounds at Montefiore Medical Center
Vivian Kaul, MD, chief of otology, neurotology, and lateral skull base in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston, was the invited speaker at Montefiore Medical Center Grand Rounds in February 2025, where she addressed disparities in cochlear implantation in adults and children.
“Many people who are clearly candidates for cochlear implantation still decide against the surgery, despite in-depth counseling delivered at their personal level of understanding,” says Dr. Kaul, an assistant professor in the department. “Much of my research has been focused on highlighting the needs of our underserved populations by tracking disparities based on race, gender, job status, zip code, marital status, and age.”
The investigators’ data showed that Black patients were 73% less likely to undergo implantation compared to their white counterparts. Asian patients were 95% less likely to undergo implantation.
“The reason behind these racial disparities is not cost, because insurance usually pays for the implant with very little financial burden on the part of the patient. The decision tends to be based on cultural factors,” she says. “For example, older Asian patients tend to think an implant is not worth the effort of surgery since their hearing loss is not life-threatening. In one study, many Black patients said they don’t want to be experimented on or feel that they have not been fully informed. There are many cultural subtleties that can’t be generalized.”
Dr. Kaul notes that married patients and younger patients tend to opt for the implant more than unmarried and older patients, even when all are eligible and receive the same counseling. “It’s important for clinicians to be cognizant in advance of counseling that some populations are less likely to move forward with surgery,” she says. “We will always have disparities regardless of what we as providers do to mitigate them.”