Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Pediatric Audiology, Lucile Packard Children's Hospital, Palo Alto, California.
JAMA Otolaryngol Head Neck Surg. 2021 Mar 1;147(3):253-260. doi: 10.1001/jamaoto.2020.5030.
Early detection and intervention of pediatric hearing loss is critical for language development and academic achievement. However, variations in the diagnostic workup and management of pediatric sensorineural hearing loss (SNHL) exist.
To identify patient and clinician factors that are associated with variation in practice on a national level.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the Optum claims database to identify 53 711 unique children with SNHL between January 1, 2008, and December 31, 2018.
National use rates and mean costs for diagnostic modalities (electrocardiogram, cytomegalovirus testing, magnetic resonance imaging, computed tomography, and genetic testing) and interventions (speech-language pathology, billed hearing aid services, and cochlear implant surgery) were reported. The associations of age, sex, SNHL laterality, clinician type, race/ethnicity, and household income with diagnostic workup and intervention use were measured in multivariable analyses.
Of 53 711 patients, 23 735 (44.2%) were girls, 2934 (5.5%) were Asian, 3797 (7.1%) were Black, 5626 (10.5%) were Hispanic, 33 441 (62.3%) were White, and the mean (SD) age was 7.3 (5.3) years. Of all patients, 32 200 (60.0%) were seen by general otolaryngologists, while 7573 (14.10%) were seen by pediatric otolaryngologists. Diagnostic workup was received by 14 647 patients (27.3%), while 13 482 (25.1%) received intervention. Use of genetic testing increased (odds ratio, 1.22 per year; 95% CI, 1.20-1.24), whereas use of computed tomography decreased (odds ratio, 0.93 per year; 95% CI, 0.92-0.94) during the study period. After adjusting for relevant covariables, children who were seen by pediatric otolaryngologists and geneticists had the highest odds of receiving workup and intervention. Additionally, racial/ethnic and economic disparities were observed in the use of most modalities of diagnostic workup and intervention for pediatric SNHL.
This cross-sectional study identified factors associated with disparities in the diagnostic workup and intervention of pediatric SNHL, thus highlighting the need for increased education and standardization in the management of this common sensory disorder.
儿童听力损失的早期发现和干预对语言发展和学业成绩至关重要。然而，儿科感觉神经性听力损失（SNHL）的诊断和管理存在差异。
确定与全国范围内实践差异相关的患者和临床医生因素。
设计、设置和参与者：本横断面研究使用 Optum 索赔数据库，确定了 2008 年 1 月 1 日至 2018 年 12 月 31 日期间 53711 名独特的 SNHL 儿童。
报告了诊断方式（心电图、巨细胞病毒检测、磁共振成像、计算机断层扫描和基因检测）和干预措施（言语-语言病理学、计费助听器服务和人工耳蜗植入手术）的全国使用率和平均费用。多变量分析测量了年龄、性别、SNHL 侧别、临床医生类型、种族/民族和家庭收入与诊断和干预使用的关联。
在 53711 名患者中，23735 名（44.2%）为女孩，2934 名（5.5%）为亚洲人，3797 名（7.1%）为黑人，5626 名（10.5%）为西班牙裔，33441 名（62.3%）为白人，平均（SD）年龄为 7.3（5.3）岁。所有患者中，32200 名（60.0%）由耳鼻喉科普通医生就诊，而 7573 名（14.10%）由儿科耳鼻喉科医生就诊。14647 名患者（27.3%）接受了诊断性检查，而 13482 名（25.1%）接受了干预。在研究期间，基因检测的使用率增加（优势比，每年 1.22；95%CI，1.20-1.24），而计算机断层扫描的使用率下降（优势比，每年 0.93；95%CI，0.92-0.94）。在调整了相关协变量后，由儿科耳鼻喉科医生和遗传学家就诊的儿童接受检查和干预的可能性最高。此外，在儿科 SNHL 的诊断性检查和干预的大多数方式的使用中，还观察到了种族/民族和经济方面的差异。
本横断面研究确定了与儿科 SNHL 诊断和干预差异相关的因素，从而突出了在管理这种常见感觉障碍方面需要增加教育和标准化。
