Understanding Access to ENT Care Among Patients with Limited English Proficiency: Presenting Patterns and Barriers

Introduction: A recent study by Himmelstein and colleagues found that patients with Limited English Proficiency (LEP) were underrepresented in otolaryngology (ENT) care. We replicated these findings using a stricter LEP definition—“Interpreter Required” in the electronic medical record—and examined whether language barriers affected access across diagnoses.

Methods: We conducted a retrospective cohort study of ENT encounters from 9/2020 to 2/2024 within a single urban tertiary health system. Whereas Himmelstein used provider-reported data from a national database, we analyzed encounter-level data. Adjusted rate ratios (ARRs) were calculated using negative binomial regression, controlling for age, sex, race, ethnicity, insurance, and ZIP-level median household income. We compared diagnosis patterns between English-proficient (EP) and LEP patients, calculated diagnosis-specific ARRs, and assessed whether geographic distance modified representation by testing the interaction between LEP status and distance.

Results: After excluding encounters with missing covariates, 74,932 patients were analyzed (EP=73,573; LEP=1,359). LEP patients were older, had lower median household income, and were more frequently insured by Medicaid. After adjustment, LEP patients had 5.1% fewer ENT encounters (ARR=0.949, 95% CI: 0.904–0.995, p=0.032), substantially smaller than the ~40% reduction reported nationally. LEP patients more often presented with bilateral sensorineural hearing loss and throat pain, whereas EP patients more frequently presented with chronic conditions such as sinusitis and rhinitis. Diagnosis-specific ARRs did not differ significantly, and distance from the hospital did not modify LEP visit rates.

Conclusions: These findings suggest that language proficiency remains an independent barrier to ENT access. However, the effect is significantly attenuated compared to national findings, potentially reflecting a more resourced care network. Notably, hearing loss was a more prevalent diagnosis in LEP populations, providing another possible barrier to navigating subspecialty care.