Researchers report that practice patterns across the US are not consistent with guidelines for the diagnosis and management of sensorineural hearing loss in young children. The rates of genetic workups for hearing loss and treatment of the disorder "need to be improved across the board," researchers said. "Increasing awareness among physicians is part of the education, and hopefully a first step in standardizing management of sensorineural hearing loss."
Practice patterns across the US are not consistent with guidelines for the diagnosis and management of sensorineural hearing loss (SNHL) in young children, researchers say.
"Children with hearing loss can be treated by physicians from different specialties - i.e., pediatric otolaryngologists, neurotologists, and medical geneticists - so we asked whether children seen by (these specialists) will get workups and treatment more or less frequently," Dr. Alan Cheng of Stanford University School of Medicine told Reuters Health by email. The study asks the same question regarding children from disadvantaged backgrounds, who are known to have poorer access to healthcare, he said.
The rates of genetic workups for hearing loss and treatment of the disorder "need to be improved across the board," he said. "Increasing awareness among physicians is part of the education, and hopefully a first step in standardizing management of SNHL."
As reported in JAMA Otolaryngology-Head and Neck Surgery, the team reviewed claims data for close to 54,000 children with SNHL (44% girls; mean age, 7.3 years; 62% White; 7% Black; 5.5% Asian) between 2008 - 2018.
Sixty percent of participants were seen by general otolaryngologists; 14%, by pediatric otolaryngologists. A diagnostic workup was given to 27.3%, whereas 25.1% received an intervention.
Use of genetic testing increased during the study period (odds ratio, 1.22 per year), whereas use of computed tomography decreased (OR, 0.93 per year).
Older children had lower odds of receiving genetic testing (OR, 0.97), but higher odds of receiving EKG (OR, 1.06), MRI (OR, 1.05), and CT (OR, 1.05).
Children with a more recent diagnosis had higher odds of receiving genetic testing (OR, 1.13) but lower odds of receiving other diagnostic modalities.
Clinician type was significantly associated with diagnostic use. Compared with general otolaryngologists, pediatric otolaryngologists had higher odds of using all diagnostic modalities; non-otolaryngologists had lower odds of using all modalities except cytomegalovirus testing.
After adjustment for relevant covariables, children who were seen by pediatric otolaryngologists and geneticists had the highest odds of a receiving workup and intervention.
Racial/ethnic and economic disparities were seen in the use of most diagnostic workup modalities and interventions.
Dr. Cheng said the team will be studying whether children without health insurance are even more severely impacted (the current study focused on those with health insurance), and will also look at different countries to see whether different healthcare policies might affect the findings.
Dr. Margaret Kenna of Boston Children's Hospital, author of a related editorial, commented in an email to Reuters Health, "Although these findings continue to be disheartening, they were not surprising. What was surprising, however, was that care provided varied by the type of clinician, with diagnostic studies and other recommendations being more likely to be ordered by pediatric otolaryngologists and geneticists compared to general otolaryngologists and neurotologists."
"This raises questions about the reasons for variability in adherence to clinical practice guidelines, especially if most of the providers received the same basic training," she said. "Number of guidelines, awareness of their existence, evidence supporting them, perceived efficacy related to patient outcomes, working knowledge of the specific diagnostic studies or interventions, risk versus benefits of an intervention, patients in that provider's practice, and need for insurance approval are all factors that may affect adherence."
"In this case," she said, "the International Pediatric Otolaryngology Group SNHL guidelines (and other guidelines) may not be routinely consulted by most otolaryngologists outside those caring for children."
"To this point," she noted, "of the 17 published - and five in development - clinical practice guidelines listed on the American Academy of Otolaryngology-Head and Neck Surgery website, none are focused on SNHL in children."
"If infants and children with SNHL are a significant portion of a providers practice, it is incumbent on the provider to obtain, and maintain, up-to-date recommendations for that patient cohort," she said. "In other words, just do it!"