Audiometric Testing Guideline Adherence in Children Undergoing Tympanostomy Tubes: A Population-Based Study
Jason A Beyea1, Emily Rosen2, Trina Stephens1
11 Department of Otolaryngology, Hotel Dieu Hospital, Kingston Health Sciences Centre, Queen's University School of Medicine, Kingston, ON, Canada.
Insights
Hearing tests before and after tympanostomy tube surgery in children are increasing but still fall short of guidelines. Younger surgeons show better adherence to pediatric hearing test recommendations.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Health Services Research
Background:
- Tympanostomy tube (TT) insertion is a common pediatric ambulatory surgery.
- Clinical Practice Guidelines (CPGs) recommend hearing testing for all pediatric TT candidates.
- Adherence to these guidelines is crucial for optimal pediatric hearing health management.
Purpose of the Study:
- To assess the rates of audiometric testing in children undergoing tympanostomy tube procedures.
- To evaluate trends in pre- and post-operative hearing tests over time.
- To identify factors influencing adherence to hearing testing guidelines.
Main Methods:
- Retrospective population-based cohort study in Ontario, Canada.
- Inclusion of 316,599 bilateral TT procedures in patients 12 years or younger (1993-2016).
- Primary outcomes: percentage of patients with hearing tests within 1 year pre- or post-surgery.
Main Results:
- Preoperative hearing tests increased from 55.7% to 74.9%; postoperative from 42.2% to 68.9%.
- Younger surgeons showed higher CPG adherence (RR 1.22).
- No significant increase in preoperative testing post-CPG introduction in 2013; wide regional variation (26.1%-83.5%).
Conclusions:
- Audiometric testing rates are increasing but remain below CPG recommendations.
- Challenges include audiology service access, parental preferences, and need for continuing medical education.
- Further efforts are needed to ensure all pediatric TT candidates receive recommended hearing evaluations.
Abstract:
Objective Tympanostomy tube (TT) insertion is the most common ambulatory surgery performed on children. American Academy of Otolaryngology-Head and Neck Surgery Founda-tion (AAO-HNSF) Clinical Practice Guidelines (CPGs) recommend hearing testing for all pediatric TT candidates. The aim of this study was to assess audiometric testing in this population. Study Design Retrospective population-based cohort study. Setting All hospitals in the Canadian province of Ontario. Subjects and Methods All patients 12 years of age and younger who underwent at least 1 TT procedure between January 1993 and June 2016. The primary outcomes were the percentage of patients who underwent a hearing test within 1 year before and/or 1 year after surgery. Results A total of 316,599 bilateral TT procedures were performed during the study period (1993 to 2016). Presurgical hearing tests increased from 55.7% to 74.9%, and postsurgical hearing tests increased from 42.2% to 68.9%. Younger surgeons demonstrated a greater adherence to the CPGs (relative risk [RR], 1.22; 95% CI, 1.08-1.38; P = .001). Remarkably, there was not a spike in preoperative hearing tests following the introduction of the CPGs in 2013 (RR, 1.12; 95% CI, 0.85-1.47; P = .432). Presurgical hearing testing ranged from 26.1% to 83.5% across health regions. Conclusion In this cohort of children who underwent TT placement, the trends of preoperative and postoperative audiometric testing are increasing but are still lower than recommended by the CPGs, despite a tripling of practicing audiologists. This study describes the current state of testing in Ontario and highlights issues of access to audiology services, possible parent preferences, and the importance of ongoing continuing medical education for all health care practitioners.
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