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Barriers to Timely Infant Hearing Loss Diagnosis Utilizing Auditory Brainstem Response
Raymond C Wadlow1, Tracey Ambrose2, Irene Sideris2
1Division of Otolaryngology, Children's National Hospital, Washington, District of Columbia, USA.
Insights
Access to Auditory Brainstem Response (ABR) testing for infants faces barriers. Delays in diagnosis impact hearing aid fitting, highlighting the need to address infant sleep, scheduling, and provider coordination for timely hearing loss identification.
Area of Science:
- Pediatric Audiology
- Hearing Science
- Health Services Research
Background:
- Access to timely Auditory Brainstem Response (ABR) testing for infants is crucial for early hearing loss diagnosis but often limited by health system constraints.
- Identifying barriers to ABR testing is essential for improving adherence to Early Hearing Detection and Intervention (EHDI) guidelines.
Purpose of the Study:
- To identify common barriers affecting the number of ABR tests required for a definitive infant hearing loss diagnosis.
- To explore factors influencing delays in diagnosis and subsequent hearing aid fitting.
Main Methods:
- Retrospective review of infant ABR data from 2019-2024 at a tertiary children's hospital.
- Univariate and multivariable regression analyses to identify barriers associated with diagnostic delays.
Main Results:
- Of 630 infants, 92% received a diagnosis via ABR. 55.6% required one ABR, while 14.7% needed three or more.
- Delays in diagnosis significantly impacted hearing aid fitting age (diagnosed after 3 months: 11.2 months vs. by 3 months: 5.9 months).
- Otolaryngology consultation was associated with delayed diagnosis (>3 months).
Conclusions:
- Common barriers include infant sleep state, provider coordination, middle ear dysfunction, facility distance, and scheduling.
- Addressing these barriers is critical for timely diagnosis and intervention, aligning with EHDI guidelines.
- Timely diagnosis by 3 months of age is associated with earlier hearing aid fitting.
Objective:
Given health system limitations, access to timely Auditory Brainstem Response (ABR) testing in infants is often challenging. The purpose of this study is to identify common barriers that may affect the number of ABRs needed to establish a definitive diagnosis of hearing loss in infants.
Study Design:
Retrospective review of variables impacting definitive diagnosis in infants who underwent ABRs from 2019 to 2024.
Setting:
Tertiary free-standing children's hospital.
Methods:
Univariate and multivariable regression analyses were used to explore potential barriers with delays in time to definitive hearing loss diagnosis and management. All statistical tests were two-sided and performed at the 0.05 level of significance.
Results:
630 patients met inclusion criteria. Of these, 579 (92%) had received a definitive diagnosis through ABR, 322 (55.6%) of which required only one ABR. 172 (29.7%) required two ABRs and 85 (14.7%) needed three or more. Time to hearing aid fitting was significantly influenced by time to definitive diagnosis. Patients diagnosed after 3 months of age were fit with a hearing aid at a significantly older age than those diagnosed by 3 months (11.2 vs 5.9 months, P = <.001). In the univariate analysis, otolaryngology consultation was associated with definitive hearing diagnosis at >3 months of age (386 vs 193, P = <.001). This association held true when controlling for other variables in multivariable analysis (aHR: 0.46, 95% CI: 0.38-0.55, P = <.001).
Conclusion:
Primary common barriers impacting appropriate and timely EHDI guidelines: Infant sleep state, coordination with other providers, middle ear dysfunction, distance to facility, and scheduling constraints.
