PP1106 - Protocol to Improve Ototoxic Monitoring for Children with Cystic Fibrosis

Cystic Fibrosis (CF) is a genetic disorder often resulting in reoccurring lung infections treated with ototoxic medications that can cause permanent sensorineural hearing loss. A retrospective chart review found insufficient audiologic monitoring for ototoxicity in the pediatric CF population at our center. The current study sought to (1) compare the percentage of CF patients on ototoxic medications getting audiologic testing before and after implementing a clinical referral program and (2) understand the barriers and facilitators to audiologic care for families through a parent survey. The new protocol significantly increased ototoxic monitoring and yielded a mostly positive reaction from families.

Summary:

Cystic Fibrosis (CF) is an autosomal recessive genetic disorder often leading to bacterial lung infections (Steyger & Garinis, 2016; Tarshish et al., 2016). Treatment frequently involves administration of ototoxic antibiotics (e.g., aminoglycosides) for continued management of infection. (Steyger & Garinis, 2016). Aminoglycosides are known to be ototoxic or damaging to the hair cells within the cochlea. This damage can result in permanent sensorineural hearing loss (SNHL; Tarshish et al., 2016). Unlike other well-established protocols for populations with high exposure to ototoxic medications (i.e., cancer patients; Abujamra et al., 2013), only recently have guidelines been established to monitor auditory function in children with CF (Garinis et al., 2021).

A retrospective chart review of children with CF who began treatment with aminoglycoside antibiotics at our center in 2018 (n = 62) revealed that only 19.4% received audiologic testing within 12 months of treatment initialization. Given the known effects of aminoglycoside antibiotics on auditory function, these findings suggest that ototoxic hearing loss in children with CF was likely underdiagnosed in our center. The current study aims to (1) determine if a clinical referral protocol implemented between our center’s CF and audiology teams increased the percentage of CF patients on ototoxic medications receiving audiologic testing, and to (2) understand the barriers and facilitators to audiologic care for families through a parent survey.

The clinical referral protocol, implemented March 1, 2023, includes a review of medical records of CF patients for exposure to ototoxic medications, including aminoglycosides (i.e., tobramycin), macrolides (i.e., azithromycin), and vancomycin. Children who are treated with ototoxic medications in outpatient settings are identified by a graduate research assistant and referred for audiologic testing. Audiologic appointments are scheduled in conjunction with quarterly CF appointments and coordinated via scheduling personnel using a secure messaging platform. Children being treated as inpatients are identified via admission emails sent out to the care team by the CF clinic and audiologic testing is completed before discharge.

To evaluate if this clinical referral protocol improved audiologic monitoring, we will compare the percentage of CF patients being treated with ototoxic medications who complete audiologic testing for one year prior to and following the implementation of the clinical referral protocol. To better understand potential barriers to audiologic care, a custom, 11-question survey will be administered to the parent using a Likert scale following the audiology visit.

Data collection is ongoing, and all results obtained through February 2024 will be presented in this poster. Preliminary findings suggest that 70.6% of CF patients who began ototoxic treatment after implementation of our clinical referral protocol have received audiology evaluations. This is more than a three-fold increase in ototoxic monitoring of children with CF, suggesting our clinical referral protocol was successful. Although preliminary parent survey results (n=24) indicate an overall positive reaction to audiologic testing, parents report less willingness to make an audiology appointment outside of quarterly CF appointments, regardless of whether a location for testing is available closer to their home. The success of our center’s simplistic protocol could easily be replicated at other centers treating patients with CF with minimal interruption to workload.