Examining the Cost of Imaging and Audiometric Testing for Pediatric Hearing Loss

By Samantha Anne, MD, MS

Hearing loss affects nearly 15 percent of children between ages 6 and 19 years. Diagnosing hearing loss and evaluating a child once hearing loss is confirmed involves an array of testing, including audiometric testing, radiologic testing and genetic testing, among others. Our pediatric otolaryngology section at Cleveland Clinic has been investigating the costs of these hearing evaluations in our patient population.

Tympanometry and OAEs vs. full audiometry

Evaluating a child with suspected hearing loss requires a reliable, reproducible and accurate audiometric test. Young children, especially those younger than 3 years, have been shown to have high rates of incomplete or failed testing attempts (manuscript in submission). One option for screening healthy children with no risk factors for hearing loss is to use otoacoustic emissions (OAEs) instead of pure-tone audiometry, and further screen children who have failed OAEs with tympanometry to evaluate middle ear status.

A study to determine the cost of combined tympanometry and otoacoustic emissions versus a comprehensive audiogram in the pediatric population found that testing with tympanometry and OAEs would save nearly $70 compared with full audiometry.

Which imaging study is best?

Once hearing loss is diagnosed, the child may undergo genetic testing, ophthalmologic examination, electrocardiogram and various laboratory testing, based on the index of suspicion in each case. In terms of radiologic evaluation of hearing loss, which test is best is still debatable. Consideration must be given to need for sedation, radiation and specific information attained from each technique.

A study completed in our department evaluated the cost of CT versus MRI, as well as differences in the need for sedation and the duration of sedation. MRI and CT give slightly different information; both are used based on individual institution’s preference. The study found that magnetic resonance imaging of the brain, internal auditory canal/cerebellopontine angle (MRI IAC/CPAs) is, in general, twice as costly as computed tomography of the temporal bone (CTTB) and almost 40 percent of patients need sedation to complete MRI IAC/CPA.

More study is needed

Cost is just one variable to consider in the evaluation of pediatric hearing loss. Further studies are needed to determine the best audiometric testing method that accurately and reliably tests young children. In addition, once a child is diagnosed, the type of testing used to investigate the cause of hearing loss will be determined on a case-by-case basis.