Abstract
Objective: 1) Determine how healthcare delivery for idiopathic sudden sensorineural hearing loss (ISSHL) is affected by delay in seeking care, initial response from healthcare provider, and timing of diagnostic audiogram and otolaryngologic consultation. 2) Determine how the above factors affect hearing recovery.
Method: Retrospective analysis of 118 ISSHL cases at Kaiser Permanente Northwest, 2001-2010. Hearing outcome was measured as percentage of recovery with pure-tone average of the unaffected ear as benchmark for 100% recovery. Variables include timing of initial contact, type of provider, initial diagnosis, action, timing for audiogram, consultation, and steroid treatment.
Results: Patients with at least 50% recovery received steroid at 9.0 ± 15.2 days whereas those with less recovery received steroid at 13.9 ± 15.0 days. Delay in seeking care differed little between the 2 groups. 15% of initial encounters involved audiologists or otolaryngologists, and 85% involved other MDs, PAs, NPs, or RNs. The former were all diagnosed correctly and averaged 70% hearing recovery, whereas the latter averaged 50% recovery. In this group, only 29% were correctly diagnosed, 34% were diagnosed incorrectly with conductive hearing loss, and 31% did not receive referral for follow-up with audiology or otolaryngology.
Conclusion: Since elapsed time adversely affects hearing recovery in ISSHL, we have identified areas in healthcare delivery where improvements can be made to facilitate timely diagnosis and management. A key objective would be better recognition of ISSHL vs conductive hearing loss among healthcare providers who triage hearing loss complaints.
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