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Mazzola S, Schreiber A. Genetics evaluation outcomes of patients with pediatric hearing loss: 2008-2022 retrospective study. Am J Otolaryngol 2024; 45:104196. [PMID: 38134852 DOI: 10.1016/j.amjoto.2023.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE This study aims to explore how genetics evaluation and testing for patients with pediatric onset hearing loss affects their diagnosis and management. METHODS Retrospective chart review was completed for patients with pediatric hearing loss that were evaluated by a genetic counselor from 2008 to 2022 with data entry into a REDCap database. Descriptive statistical analysis was completed. RESULTS Four hundred twenty-nine patients with pediatric onset hearing loss were evaluated by genetics. Majority of patients presented with bilateral (67 %) and sensorineural (83 %) hearing loss. Genetic testing was recommended for 76 % of patients with pediatric hearing loss evaluated by a genetic counselor with 70 % completing some or all recommended tests. Overall genetic testing diagnostic rate was 34 %, with 41 % of diagnoses syndromic. Yearly trends noted an increasing number of patients evaluated, tests ordered, and subsequently an increased number of diagnoses overtime. For diagnostic results, management recommendations were made for 45 % of patients (35/78) and for 92 % of family members (72/78). This compared to total management recommendations for all patients (82/429, 19 %) and family members (110/429, 26 %). CONCLUSION This study identified a genetic testing diagnostic rate for pediatric hearing loss of 34 % over 14 years. This study notes the beneficial outcomes of patients with hearing loss and their families meeting with a genetic counselor and the importance of collaboration with hearing loss management colleagues. It highlights the value a genetic counselor consult can add to a patient's diagnostic journey, in addition to how genetic testing impacts management for patients and their families.
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Affiliation(s)
- Sarah Mazzola
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH, United States of America.
| | - Allison Schreiber
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH, United States of America
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Heyward A, Hagerty K, Lichten L, Howell J, Tey CS, Dedhia K, Kavalieratos D, Govil N. The qualitative experiences of otolaryngologists with genetic services in pediatric hearing loss evaluation. J Community Genet 2023; 14:377-385. [PMID: 37156903 PMCID: PMC10444707 DOI: 10.1007/s12687-023-00649-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
Genetic testing is one of the most high-yield diagnostic tests in the evaluation of pediatric sensorineural (SNHL) hearing loss, leading to a genetic diagnosis in 40-65% of patients. Previous research has focused on the utility of genetic testing in pediatric SNHL and otolaryngologists' general understanding of genetics. This qualitative study examines otolaryngologists' perceptions about facilitators and barriers when ordering genetic testing in the workup of pediatric hearing loss. Potential solutions for overcoming barriers are also explored. Eleven (N = 11) semi-structured interviews were conducted with otolaryngologists in the USA. Most participants were currently practicing in a southern, academic, urban setting and had completed a pediatric otolaryngology fellowship. Insurance was one of the main barriers to testing, and increased genetics provider accessibility was the most frequently cited solution to increase utilization of genetic services. Difficulty acquiring insurance coverage and unfamiliarity with the genetic testing process were the most common reasons otolaryngologists referred patients to genetics clinics for genetic testing, as opposed to ordering testing themselves. This study suggests that otolaryngologists recognize the importance and utility of genetic testing, but a lack of genetics-specific skills, knowledge, and resources makes it difficult for them to facilitate testing. Multidisciplinary hearing loss clinics that include genetics providers may increase the overall accessibility of genetic services.
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Affiliation(s)
- Aaliyah Heyward
- Genetics Department, Ochsner Health Medical Center, New Orleans, LA, 70121, USA
- Genetic Counseling Training Program, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Kelsi Hagerty
- Genetic Counseling Training Program, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
- Pediatric Hematology/ Oncology, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Lauren Lichten
- Pediatric Hematology/ Oncology, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Julie Howell
- Genetics Department, Kaiser Permanente, 20 Glenlake Pkwy NE, Sandy Springs, GA, 30328, USA
| | - Ching Siong Tey
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, 1400 Tullie Road, Atlanta, GA, 30323, USA
| | - Kavita Dedhia
- Otolaryngology Head and Neck Surgery, The Children's Hospital of Philadelphia and University of Pennsylvania, 3500 Civic Center Blvd, 5Th Floor, Philadelphia, PA, 19104, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Nandini Govil
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, 1400 Tullie Road, Atlanta, GA, 30323, USA.
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Roles and reported practices of paediatricians in the early identification and monitoring of hearing impairment in high-risk newborns and infants. Int J Pediatr Otorhinolaryngol 2023; 165:111448. [PMID: 36682223 DOI: 10.1016/j.ijporl.2023.111448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/15/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND The paediatrician is often the first professional who provides care for the infant and their families, hence having a vital role in the early identification and intervention of hearing impairment. OBJECTIVE This study aimed to identify the role and reported practices of paediatricians in the early identification and monitoring of hearing impairment in high-risk newborns and infants. METHODS The sample comprised 30 paediatricians in South Africa. Data were collected by means of an online survey and analysed using descriptive statistics. RESULTS Variability was noted in the early identification protocols, with most participants conducting objective measures. Although most participants refer newborns and infants for audiological evaluation when hearing impairment is suspected, there is variability with regard to the age at which they are referred. Approximately 98% of participants believe that they form part of the multidisciplinary team; however, only 69% reported that they have actually been part of a multidisciplinary team. CONCLUSIONS Paediatricians had sufficient knowledge regarding the assessment of hearing impairment and their role in the early hearing detection and intervention programme. There is however a need for information sharing regarding appropriate hearing screening measures.
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Zhang L, Links AR, Boss EF, White A, Walsh J. Identification of Potential Barriers to Timely Access to Pediatric Hearing Aids. JAMA Otolaryngol Head Neck Surg 2021; 146:13-19. [PMID: 31600386 DOI: 10.1001/jamaoto.2019.2877] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Despite various barriers identified to early pediatric access to cochlear implantation, barriers to timely access to pediatric hearing aids are not well characterized. Objective To identify socioeconomic, demographic, and clinical factors that may be associated with pediatric access to hearing aids. Design, Setting, and Participants This retrospective cohort study included 90 patients aged 1 to 15 years who were referred for auditory brainstem response (ABR) testing and evaluation for hearing aids at a single tertiary care academic medical center from March 2004 to July 2018. Children who did not receive both ABR testing and hearing aids at the same center were excluded from analysis. Main Outcomes and Measures Associations of insurance type (private vs public), race/ethnicity (white vs other), primary language (English vs other), cause of hearing loss (complex vs not complex), zip code, hearing aid manufacturer, and severity of hearing loss (in decibels) with the duration of intervals from newborn hearing screening to ABR testing, from ABR testing to ordering of hearing aids, and from ABR testing to dispensing of hearing aids. Results Of the 90 patients, mean (SD) age was 5.6 (3.7) years, 56% were female, and 77 (86%) were non-Hispanic. Results of χ2 tests indicated significant assocations existed between public insurance and race/ethnicity and between public insurance and primary language other than English. Variables associated with the interval from newborn hearing screening to ABR testing included insurance type (mean difference, 7.4 months; 95% CI, 2.6-12.2 months) and race/ethnicity (mean difference, 6.9 months; 95% CI, 2.7-11.1 months). Increased delays between birth and a child's first ABR test were associated with public insurance (mean difference, 6.0 months; 95% CI, 1.8-10.2 months) and race/ethnicity other than white (mean difference, 6.0 months; 95% CI, 2.3-9.7 months). The mean time from birth to initial ABR testing was a mean of 6 months longer for patients from non-English-speaking families than for those from English-speaking families (mean [SD] interval, 14.9 [16.3] months vs 9.0 [8.5] months), although the difference was not statistically significant. Severity of hearing loss was associated with a decrease in the interval from ABR testing to ordering of hearing aids after accounting for other potential barriers (odds ratio, 0.6; 95% CI, 0.4-0.9). Zip code and complexity of the child's medical condition did not appear to be associated with timely access to pediatric hearing aids. Conclusions and Relevance This study's findings suggest that insurance type, race/ethnicity, and primary language may be barriers associated with pediatric access to hearing aids, with the greatest difference observed in time to initial ABR testing. Clinical severity of hearing loss appeared to be associated with a significant decrease in time from ABR testing to ordering of hearing aids. Greater efforts to assist parents with ABR testing and coordination of follow-up may help improve access for other at-risk children.
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Affiliation(s)
- Lisa Zhang
- Medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alicia White
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ronner E, Basonbul R, Bhakta R, Mankarious L, Lee DJ, Cohen MS. Impact of cochlear abnormalities on hearing outcomes for children with cochlear implants. Am J Otolaryngol 2020; 41:102372. [PMID: 31883754 DOI: 10.1016/j.amjoto.2019.102372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Evaluate the impact of cochlear anomalies on hearing outcomes for pediatric patients with cochlear implants. STUDY DESIGN Retrospective chart review. SETTING Tertiary care center. SUBJECTS AND METHODS Charts were retrospectively reviewed for cases where pediatric cochlear implant surgery was performed between 2002 and 2018 at a single, tertiary care institution. Patients were divided into groups based on the presence or absence of radiological cochlear abnormalities, which were further classified as low or high risk anomalies. Hearing outcomes were evaluated by measuring pure tone averages and word recognition scores preoperatively, 3 and 12 months postoperatively, in addition to the most recent test results. RESULTS There were 154 ears implanted in our cohort of 100 patients. 107 ears had normal cochlear anatomy, 31 had low risk, and 16 had high risk abnormalities. The most common modality of preoperative imaging was CT scan. Postoperative mean pure tone average (PTA) was significantly higher in patients with inner ear anomalies compared to those with normal anatomy. No significant difference in PTA was noted between low versus high risk patients. <50% of patients had word recognition scores available within the first year following surgery. CONCLUSION Abnormalities of the inner ear significantly influenced hearing outcomes over time following cochlear implant surgery when compared to pediatric patients with normal anatomy. Obtaining hearing testing can be difficult in very young children and therefore future studies are warranted to further investigate the impact that cochlear abnormalities may have on hearing outcomes following cochlear implant surgery.
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Ronner EA, Benchetrit L, Levesque P, Basonbul RA, Cohen MS. Quality of Life in Children with Sensorineural Hearing Loss. Otolaryngol Head Neck Surg 2019; 162:129-136. [PMID: 31684823 DOI: 10.1177/0194599819886122] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess quality of life (QOL) in pediatric patients with sensorineural hearing loss (SNHL) with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) and the Hearing Environments and Reflection on Quality of Life 26 (HEAR-QL-26) and HEAR-QL-28 surveys. STUDY DESIGN Prospective longitudinal study. SETTING Tertiary care center. SUBJECTS AND METHODS Surveys were administered to patients with SNHL (ages 2-18 years) from July 2016 to December 2018 at a multidisciplinary hearing loss clinic. Patients aged >7 years completed the HEAR-QL-26, HEAR-QL-28, and PedsQL 4.0 self-report tool, while parents completed the PedsQL 4.0 parent proxy report for children aged ≤7 years. Previously published data from children with normal hearing were used for controls. The independent t test was used for analysis. RESULTS In our cohort of 100 patients, the mean age was 7.7 years (SD, 4.5): 62 participants had bilateral SNHL; 63 had mild to moderate SNHL; and 37 had severe to profound SNHL. Sixty-eight patients used a hearing device. Mean (SD) total survey scores for the PedsQL 4.0 (ages 2-7 and 8-18 years), HEAR-QL-26 (ages 7-12 years), and HEAR-QL-28 (ages 13-18 years) were 83.9 (14.0), 79.2 (11.1), 81.2 (9.8), and 77.5 (11.3), respectively. Mean QOL scores for patients with SNHL were significantly lower than those for controls on the basis of previously published normative data (P < .0001). There was no significant difference in QOL between children with unilateral and bilateral SNHL or between children with SNHL who did and did not require a hearing device. Low statistical power due to small subgroup sizes limited our analysis. CONCLUSION It is feasible to collect QOL data from children with SNHL in a hearing loss clinic. Children with SNHL had significantly lower scores on validated QOL instruments when compared with peers with normal hearing.
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Affiliation(s)
- Evette A Ronner
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | | | - Patricia Levesque
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Razan A Basonbul
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Campbell T, Chen CYJ, Chhina H, Chahal R, Cooper A, Elliott AM. Support, information, and integration of genetics for children with congenital lower limb deficiencies in British Columbia, Canada. Paediatr Child Health 2019; 24:395-401. [PMID: 31528111 DOI: 10.1093/pch/pxz001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/20/2018] [Indexed: 01/31/2023] Open
Abstract
Objectives Children and families affected by congenital limb deficiencies (CLD) require a unique level of emotional support from diagnosis through to adolescence. The following study aims to collect data on Canadian paediatric patients affected by a CLD followed at BC Children's Hospital (BCCH), Department of Orthopaedics. Methods Parents of children with a CLD were asked to complete a written questionnaire examining their experiences. Qualitative and quantitative data were collected concerning parent satisfaction with patient referrals, emotional support, and knowledge of their child's diagnosis. Results Twenty-five completed questionnaires were returned. Fifty per cent of the parents reported they were either very satisfied, or satisfied, with the emotional support provided by health care providers (HCPs). Twenty-five per cent of the parents were unsatisfied with the emotional support received by HCPs. Forty-eight per cent of the parents could not recall the specific name of their child's diagnosis; 20% of the parents reported their child did not have diagnosis. All the patients in our study had received a clinical diagnosis. Twenty-eight per cent of the parents in this study were also seen in medical genetics. Conclusions Families require additional resources for emotional support, peer support, and referrals to support organizations. Gaps in parent knowledge regarding their child's CLD suggest the need for formalized communication strategies for HCPs. Furthermore, patients with CLDs and their families may benefit from improved communication between orthopaedic and medical genetic services at the time of diagnosis. Integration of genetic counsellors may improve emotional supports and education for families with regards to testing and reproductive planning.
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Affiliation(s)
- Teresa Campbell
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
| | - Ching-Yi Jenny Chen
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
| | - Harpreet Chhina
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia
| | - Rajpreet Chahal
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia
| | - Anthony Cooper
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia.,Department of Orthopaedics, BC Children's Hospital, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia.,Women's Hospital Research Institute, Vancouver, British Columbia
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