What is the optimal workup for a child with bilateral sensorineural hearing loss?

Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. U.S.A.. .
The Laryngoscope (Impact Factor: 2.14). 04/2013; 123(4):809-10. DOI: 10.1002/lary.23425
Source: PubMed
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    ABSTRACT: Objectives/HypothesisTo determine the feasibility and cost effectiveness of incorporating cytomegalovirus (CMV) testing to determine the etiology of pediatric hearing loss. Study DesignRetrospective study of children presenting with sensorineural hearing loss (SNHL) at one institution from 2008 to 2013. Methods Children aged 3 years or younger who presented to the senior author (A.P.) between May 2008 and September 2013 with confirmed SNHL were evaluated. These children underwent a sequential diagnostic paradigm that incorporated CMV testing if no obvious etiology could be determined from the history or physical examination. ResultsOne hundred eleven children with SNHL were evaluated between 2008 and 2013. Eighty-three children underwent CMV testing, imaging, and a genetic evaluation. Those with confirmed or probable CMV-induced SNHL made up 30% of all children tested (n=25), the largest group identified. CMV screening had the lowest cost compared to genetic testing or imaging for all types of hearing loss, except for those with auditory neuropathy spectrum disorder. Conclusion We present the first sequential diagnostic paradigm utilizing CMV testing for children presenting with SNHL. The relatively high incidence of CMV-induced SNHL, the low cost for this assay, and the indirect benefits from early diagnosis support the role of early CMV testing for these patients. Level of Evidence4. Laryngoscope, 124:2624-2629, 2014
    The Laryngoscope 11/2014; 124(11). DOI:10.1002/lary.24752 · 2.14 Impact Factor
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    ABSTRACT: 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. 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. 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. 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%). 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. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
    Otolaryngology Head and Neck Surgery 07/2015; DOI:10.1177/0194599815596727 · 2.02 Impact Factor


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