Evaluation of audiologic impairment in critically ill patients: results of a screening protocol

Abstract

Objective: To assess hearing impairment in adults admitted to a university surgical intensive care unit in order to identify patients at risk for impaired receptive communication.

Design: Prospective, clinical, observational study within the continuing quality improvement program.

Setting: Ten-bed adult surgical intensive care unit at a university hospital.

Patients: Patients were 442 adult patients admitted to the surgical intensive care unit for trauma, a critical illness, or postoperative monitoring.

Interventions: As part of a continuing quality improvement protocol, adults admitted to the surgical intensive care unit were screened for hearing loss. Screening included otoscopy, tympanometry, and distortion product otoacoustic emissions as near the time of admission as was possible. Testing was available only on weekdays.

Measurements and main results: Audiologic testing was performed on day 1.7 +/- 3.0 and took 9.3 mins (range, 5-17 min). The women studied (n = 177, 56.2 +/- 18.2 yrs) were significantly older than the men (n = 265, 51.2 +/- 17.8 yrs, p <.0001). We found that 71.4% of patients had normal otoscopy. Only 42.5% of patients passed tympanometry. True failures accounted for 37.3% of patients and technical failures for 20.2%. Distortion product otoacoustic emission (DPOAE) testing was performed on 97.4% of ears. Only 36.2% of patients passed; 58.4% of ears failed, suggesting clinically significant auditory impairment. DPOAE results correlated with age. The pass rate was approximately 60% for patients <40 yrs of age but declined steadily by decade to <7% in patients >80 yrs. The mean age of passed DPOAE (44.2 +/- 16.2 yrs) was significantly younger than patients who failed DPOAE (60.0 +/- 16.6 yrs, p <.0001).

Conclusions: Adult patients admitted to the surgical intensive care unit for trauma, postoperative monitoring, or critical illness are at significant risk of impaired auditory reception. Almost two thirds of patients studied failed the screening protocol. Risk of failure increases with age and male gender. Screening with otoscopy, tympanometry, and DPOAE is an efficient and sensitive way to identify patients at risk for impaired auditory acuity.