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Pediatric tracheostomy audiometric outcomes - A quality improvement initiative
Ajay M Narayanan1, Helene Dabbous1, Rachel St John2
1Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Pediatric tracheostomy patients often experience hearing loss. Quality improvement initiatives increased audiometric testing rates within 12 months for these children, aiding early identification and intervention for hearing impairments.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Quality Improvement Science
Background:
- Children with tracheostomies have a high prevalence of hearing loss.
- Medical complexity in these patients often delays hearing loss identification.
- Established protocols for hearing monitoring in pediatric tracheostomy patients are lacking.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative.
- To increase the rate of audiometric testing within 12 months of tracheostomy placement in pediatric patients.
- To improve early detection of hearing loss in this vulnerable population.
Main Methods:
- Retrospective cohort study of children under 18 months undergoing tracheostomy (2012-2020).
- Analysis of audiometric assessment rates before and after quality improvement project implementation in 2015.
- Review of hearing loss characteristics and timing of assessments.
Main Results:
- Audiometric testing rates within 12 months increased from 32% (pre-QI) to 55% (post-QI, 2018-2020) (P=.01).
- Hearing loss was identified in 44% of tested children, including those with normal newborn hearing screens.
- Delayed-onset hearing loss was observed in 23% of children who initially passed audiometric exams.
Conclusions:
- Quality improvement initiatives can significantly improve audiometric assessment rates in pediatric tracheostomy patients.
- Consistent hearing monitoring is crucial for this population due to high rates of hearing loss, including delayed onset.
- Implementing audiometric protocols can mitigate speech and language development delays associated with hearing impairment.
Objective:
Pediatric tracheostomy patients disproportionately experience hearing loss and are at risk for delayed identification due to their medical complexity. Nonetheless, protocols to monitor hearing in these children are lacking. This quality improvement (QI) initiative aimed to increase the rates of audiometric testing within 12 months of pediatric tracheostomy placement.
Methods:
A retrospective cohort study included children who underwent tracheostomy under 18 months of age between 2012 and 2020. Rates of audiometric assessments before and after QI project implementation (2015) were reported along with hearing loss characteristics.
Results:
A total of 253 children met inclusion. Before project initiation (2012-2014), 32% of children (28/87) obtained audiometric testing within 12 months after tracheostomy. During the first three years of implementation (2015-2017), 39% (38/97) were tested, while 55% (38/69) were tested during the subsequent three years (2018-2020) (P = .01). A passing newborn hearing screen was obtained for 70% of the 210 children with a recorded result, and 198 survived at least 12 months to receive audiometric testing at a median of 11.3 months (IQR: 6.2-22.8) after tracheostomy. Hearing loss was identified for 44% of children (N = 88), of which 42 children initially passed newborn hearing screen. A second assessment was obtained for 62% of children (123/198) at a median of 11.3 months (IQR: 4.5-17.5) after the initial test. In this group, 23% with a previously normal audiometric exam were found to have hearing loss (15/66).
Conclusions:
QI initiatives designed to monitor hearing loss in children with a tracheostomy can result in improved rates of audiometric assessments. This population has disproportionately high rates of hearing loss, including delayed onset hearing loss making audiometric protocols valuable to address speech and language development delays.
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