Dataset Information

Sensorineural Hearing Loss: A Changing Paradigm for Its Evaluation.

ABSTRACT: OBJECTIVE:To determine how practicing clinicians evaluate patients with sensorineural hearing loss (SNHL) and to analyze the cost-effectiveness of current algorithms in the evaluation of these patients. STUDY DESIGN/SETTING:An interactive online survey allowing respondents to order diagnostic testing in the evaluation of 4 simulated patients with SNHL across 2 testing encounters per patient. SUBJECTS AND METHODS:The survey was distributed to clinician members of the American Society of Pediatric Otolaryngology and the American Society of Human Genetics between May and August 2014. Statistical tests included chi-square and nonparametric testing with Mann-Whitney U test. RESULTS:Otolaryngologists were significantly more likely than other clinicians to order repeat audiometric testing and significantly less likely to order genetic testing. Respondents who completed training more recently were significantly more likely to order magnetic resonance imaging and electrocardiogram. On average, respondents spent $4756 in the evaluation of a single patient, with otolaryngologists spending significantly more than other clinicians. Computed tomography of the temporal bone (40%), ophthalmology consultation (39%), and genetics consultation (37%) were ordered most frequently in the first encounter. Comprehensive genetic testing was ordered least frequently on the first encounter (20%) but was the most frequently ordered test on the second encounter (30%). CONCLUSION:Recent guidelines advocate comprehensive genetic testing in the evaluation of patients with SNHL, as early genetic testing can prevent uninformative additional tests that otherwise increase health care expenditures. Results from this survey indicate that comprehensive genetic testing is now frequently but not uniformly included in evaluation of patients with SNHL.

SUBMITTER: Jayawardena ADL

PROVIDER: S-EPMC4730883 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Sensorineural Hearing Loss: A Changing Paradigm for Its Evaluation.

Jayawardena Asitha D L ADL Shearer A Eliot AE Smith Richard J H RJH

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 20150727 5

<h4>Objective</h4>To determine how practicing clinicians evaluate patients with sensorineural hearing loss (SNHL) and to analyze the cost-effectiveness of current algorithms in the evaluation of these patients.<h4>Study design/setting</h4>An interactive online survey allowing respondents to order diagnostic testing in the evaluation of 4 simulated patients with SNHL across 2 testing encounters per patient.<h4>Subjects and methods</h4>The survey was distributed to clinician members of the America ...[more]

PMID: 26216887

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Project description:IntroductionTo compare inpatient treated patients with idiopathic (ISSNHL) and non-idiopathic sudden sensorineural hearing loss (NISSNHL) regarding frequency, hearing loss, treatment and outcome.MethodsAll 574 inpatient patients (51% male, median age: 60 years) with ISSNHL and NISSNHL, who were treated in federal state Thuringia in 2011 and 2012, were included retrospectively. Univariate and multivariate statistical analyses were performed.ResultsISSNHL was diagnosed in 490 patients (85%), NISSNHL in 84 patients (15%). 49% of these cases had hearing loss due to acute otitis media, 37% through varicella-zoster infection or Lyme disease, 10% through Menière disease and 7% due to other reasons. Patients with ISSNHL and NISSNHL showed no difference between age, gender, side of hearing loss, presence of tinnitus or vertigo and their comorbidities. 45% of patients with ISSNHL and 62% with NISSNHL had an outpatient treatment prior to inpatient treatment (p < 0.001). The mean interval between onset of hearing loss to inpatient treatment was shorter in ISSNHL (7.7 days) than in NISSNHL (8.9 days; p = 0.02). The initial hearing loss of the three most affected frequencies in pure-tone average (3PTAmax) scaled 72.9 dBHL ± 31.3 dBHL in ISSNHL and 67.4 dBHL ± 30.5 dBHL in NISSNHL. In the case of acute otitis media, 3PTAmax (59.7 dBHL ± 24.6 dBHL) was lower than in the case of varicella-zoster infection or Lyme disease (80.11 dBHL ± 34.19 dBHL; p = 0.015). Mean absolute hearing gain (Δ3PTAmaxabs) was 8.1 dB ± 18.8 dB in patients with ISSNHL, and not different in NISSNHL patients with 10.2 dB ± 17.6 dB. A Δ3PTAmaxabs ≥ 10 dB was reached in 34.3% of the patients with ISSNHL and to a significantly higher rate of 48.8% in NISSNHL patients (p = 0.011).ConclusionsISSNHL and NISSNHL show no relevant baseline differences. ISSNHL tends to have a higher initial hearing loss. NISSHNL shows a better outcome than ISSNHL.

Dataset Information

Sensorineural Hearing Loss: A Changing Paradigm for Its Evaluation.

Publications

Sensorineural Hearing Loss: A Changing Paradigm for Its Evaluation.

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