title: Sensorineural Hearing Loss: A Changing Paradigm for Its Evaluation.
abstract: OBJECTIVE
  To determine how practicing clinicians evaluate patients with sensorineural hearing loss (SNHL) and to analyze the cost-effectiveness of current algorithms in the evaluation of these patients.
  
  
  METHODS
  An interactive online survey allowing respondents to order diagnostic testing in the evaluation of 4 simulated patients with SNHL across 2 testing encounters per patient.
  
  
  METHODS
  The survey was distributed to clinician members of the American Society of Pediatric Otolaryngology and the American Society of Human Genetics between May and August 2014. Statistical tests included chi-square and nonparametric testing with Mann-Whitney U test.
  
  
  RESULTS
  Otolaryngologists were significantly more likely than other clinicians to order repeat audiometric testing and significantly less likely to order genetic testing. Respondents who completed training more recently were significantly more likely to order magnetic resonance imaging and electrocardiogram. On average, respondents spent $4756 in the evaluation of a single patient, with otolaryngologists spending significantly more than other clinicians. Computed tomography of the temporal bone (40%), ophthalmology consultation (39%), and genetics consultation (37%) were ordered most frequently in the first encounter. Comprehensive genetic testing was ordered least frequently on the first encounter (20%) but was the most frequently ordered test on the second encounter (30%).
  
  
  CONCLUSIONS
  Recent guidelines advocate comprehensive genetic testing in the evaluation of patients with SNHL, as early genetic testing can prevent uninformative additional tests that otherwise increase health care expenditures. Results from this survey indicate that comprehensive genetic testing is now frequently but not uniformly included in evaluation of patients with SNHL.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
authors.forename: Asitha D L
authors.initials: ADL
authors.lastname: Jayawardena
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
authors.forename: A Eliot
authors.initials: AE
authors.lastname: Shearer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.|Interdepartmental PhD Program in Genetics, University of Iowa, Iowa City, Iowa, USA.|Department of Molecular Physiology & Biophysics, University of Iowa College of Medicine, Iowa City, Iowa, USA.
authors.forename: Richard J H
authors.initials: RJH
authors.lastname: Smith
mesh_terms: D000328:Adult; D000465:Algorithms; D001299:Audiometry / Q000379:methods*; D002648:Child; D005260:Female; D005820:Genetic Testing / Q000379:methods*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012017:Referral and Consultation; D013701:Temporal Bone / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: DNA sequencing; deafness; genetic testing; hearing loss