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Early Hearing Detection and Intervention

Timely Diagnosis, Timely Management

Findlen, Ursula M.1,2; Hounam, Gina M.1; Alexy, Emily3; Adunka, Oliver F.2,4

doi: 10.1097/AUD.0000000000000647
Research Article
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Objective: A quality improvement study was completed to assess the impact of three clinical practice changes on the timing of diagnosis and intervention for congenital hearing loss.

Design: A retrospective chart review was conducted for 800 infants evaluated for congenital hearing loss before and after implementing three clinical practice changes: the use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expediting scheduling of initial assessment. The impact of middle ear involvement on age at diagnosis and history of neonatal intensive care unit stay on age at treatment was also examined.

Results: The use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expedited scheduling of initial assessment each resulted in a decrease of age at diagnosis. Ultimately, the age at initial assessment was the only significant predictor related to decreased timeline for diagnosis. Middle ear pathology significantly increased age at diagnosis, while history of time in the neonatal intensive care unit significantly increased the age at provision of amplification as a treatment for permanent hearing loss.

Conclusions: The technology used for assessment, clinical protocol, and timing of assessment of infants can impact the timeline for diagnosis and treatment of congenital hearing impairment. Given the significant sequelae of delayed or missed diagnosis of hearing loss in infancy, implementing clinical practice changes should be considered at pediatric diagnostic centers.

1Division of Clinical Therapies, Audiology Department, Nationwide Children’s Hospital, Columbus, Ohio, USA

2Department of Otolaryngology, Head & Neck Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA

3Research Institute Biostatistics, Nationwide Children’s Hospital, Columbus, Ohio, USA

4Pediatric Otology & Hearing Program, Nationwide Children’s Hospital, Columbus, Ohio, USA.

Received October 27, 2017; accepted June 19, 2018.

The authors have no conflicts of interest to disclose.

Address for correspondence: Ursula M. Findlen, Nationwide Children’s Hospital, 700 Children’s Drive, Suite T3D, Columbus, OH 43205, USA. E-mail: ursula.findlen@nationwidechildrens.org

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