Analysis of Adherence to AAO-HNSF Clinical Practice Guidelines for Sudden Hearing Loss.

IF 2.6 3区医学 Q1 OTORHINOLARYNGOLOGY Otolaryngology- Head and Neck Surgery Pub Date : 2024-11-05 DOI:10.1002/ohn.1050

Bao Y Sciscent, F Jeffrey Lorenz, Hänel W Eberly, Andrew J Rothka, Mark E Whitaker, Neerav Goyal

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Abstract

Objective: To assess adherence to the 2019 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) guidelines for the diagnosis and management of sudden hearing loss (SHL) and sudden sensorineural hearing loss (SSNHL).

Study design: Retrospective cohort.

Setting: TriNetX, a de-identified healthcare database.

Methods: Evaluation focused on the percentage of patients undergoing proper guideline-adherent workup and treatment for SHL. Key measures include audiogram testing within 2 weeks for distinguishing SSNHL from CHL. For SSNHL patients, MRI or auditory brainstem response (ABR) testing should be obtained, and steroids and/or hyperbaric oxygen may be offered within 2 weeks.

Results: There were 24,203 SHL patients, 59.1% (n = 14,309) of whom underwent recommended audiogram testing, with 35.8% (n = 8,674) completing it within 2 weeks. Overall, 3,107 were diagnosed with unilateral SSNHL, 104 with unilateral conductive hearing loss (CHL), 121 with mixed hearing loss, and 10,977 were lost to follow-up. Among 3,107 SSNHL cases, just 25.5% (n = 791) obtained MRI/ABR within 1 month, and vestibular schwannoma was diagnosed in 3.5% (n = 28). Additionally, steroids were prescribed to 54.5% (n = 1,692), and <0.3% (n ≤ 10) received hyperbaric oxygen. In accordance with strong recommendations against or insufficient evidence to support the following diagnostics and treatments, 2.0% (n = 63) underwent a CT scan, less than 0.3% (n ≤ 10) were prescribed vasodilators or thrombolytics, and 3.5% (n = 108) were on antivirals.

Conclusion: There is a significant opportunity for improvement in evaluating patients with SHL, specifically SSNHL. Proper adherence to guidelines may improve screening, detection, and management of neurotologic pathologies, including vestibular schwannoma.

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对遵守《AAO-HNSF 突发性听力损失临床实践指南》情况的分析。

目的评估2019年美国耳鼻咽喉头颈外科学会（AAO-HNSF）突发性听力损失（SHL）和突发性感音神经性听力损失（SSNHL）诊断和管理指南的遵守情况：研究设计：回顾性队列：环境：TriNetX，一个去标识化的医疗数据库：评估重点是对 SHL 患者进行符合指南要求的检查和治疗的比例。主要措施包括在 2 周内进行听力图测试，以区分 SSNHL 和 CHL。对于SSNHL患者，应进行核磁共振成像或听性脑干反应（ABR）测试，并在2周内提供类固醇和/或高压氧：共有 24,203 名 SHL 患者，其中 59.1%（n=14,309）的患者接受了建议的听力图测试，35.8%（n=8,674）的患者在 2 周内完成了测试。总体而言，3107 人被诊断为单侧 SSNHL，104 人被诊断为单侧传导性听力损失 (CHL)，121 人被诊断为混合性听力损失，10977 人失去了随访机会。在 3107 例 SSNHL 患者中，仅有 25.5%（n = 791）的患者在 1 个月内进行了 MRI/ABR，3.5%（n = 28）的患者被诊断为前庭分裂瘤。此外，54.5%（n = 1,692）的患者被处方类固醇药物，结论是：对 SHL（尤其是 SSNHL）患者的评估工作大有改进的余地。正确遵循指南可改善包括前庭分裂瘤在内的神经病理学病变的筛查、检测和管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学

CiteScore

6.70

自引率

2.90%

发文量

250

审稿时长

2-4 weeks

期刊介绍： Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.