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. 2025 Mar;172(3):868-872.
doi: 10.1002/ohn.1050. Epub 2024 Nov 5.

Analysis of Adherence to AAO-HNSF Clinical Practice Guidelines for Sudden Hearing Loss

Affiliations

Analysis of Adherence to AAO-HNSF Clinical Practice Guidelines for Sudden Hearing Loss

Bao Y Sciscent et al. Otolaryngol Head Neck Surg. 2025 Mar.

Abstract

Objective: To assess adherence to the 2019 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) guidelines for the diagnosis and management of sudden hearing loss (SHL) and sudden sensorineural hearing loss (SSNHL).

Study design: Retrospective cohort.

Setting: TriNetX, a de-identified healthcare database.

Methods: Evaluation focused on the percentage of patients undergoing proper guideline-adherent workup and treatment for SHL. Key measures include audiogram testing within 2 weeks for distinguishing SSNHL from CHL. For SSNHL patients, MRI or auditory brainstem response (ABR) testing should be obtained, and steroids and/or hyperbaric oxygen may be offered within 2 weeks.

Results: There were 24,203 SHL patients, 59.1% (n = 14,309) of whom underwent recommended audiogram testing, with 35.8% (n = 8,674) completing it within 2 weeks. Overall, 3,107 were diagnosed with unilateral SSNHL, 104 with unilateral conductive hearing loss (CHL), 121 with mixed hearing loss, and 10,977 were lost to follow-up. Among 3,107 SSNHL cases, just 25.5% (n = 791) obtained MRI/ABR within 1 month, and vestibular schwannoma was diagnosed in 3.5% (n = 28). Additionally, steroids were prescribed to 54.5% (n = 1,692), and <0.3% (n ≤ 10) received hyperbaric oxygen. In accordance with strong recommendations against or insufficient evidence to support the following diagnostics and treatments, 2.0% (n = 63) underwent a CT scan, less than 0.3% (n ≤ 10) were prescribed vasodilators or thrombolytics, and 3.5% (n = 108) were on antivirals.

Conclusion: There is a significant opportunity for improvement in evaluating patients with SHL, specifically SSNHL. Proper adherence to guidelines may improve screening, detection, and management of neurotologic pathologies, including vestibular schwannoma.

Keywords: clinical practice guidelines; guideline adherence; hearing loss; sudden hearing loss; sudden sensorineural hearing loss.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Adherence to guidelines for sudden hearing loss. ABR, auditory brainstem response; CHL, conductive hearing loss; CT, computed tomography; injection, intratympanic steroid injection; Med, steroid medication; Mo, months; MRI, magnetic resonance imaging; SSNHL, sudden sensorineural hearing loss; Wk, week.

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