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Otolaryngology

Telemedicine for Patients With Unilateral Sudden Hearing Loss in the COVID-19 Era

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: December 23, 2021

Original Investigation

Article Information and Disclosures

Shahaf Shilo, MD¹;

Omer J. Ungar, MD¹;

Ophir Handzel, MD¹;

Rani Abu Eta, MD¹;

Udi Shapira, MD, MPH¹;

Nidal Muhanna, MD, PhD¹;

Yahav Oron, MD¹

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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Key Points

Question Can telemedicine be used to differentially diagnose unilateral sudden hearing loss (SHL)?

Findings This cohort study comprised 51 patients with unilateral SHL evaluated with a telemedicine model that included self-performed Weber tests and app-based audiometry. The model’s sensitivity, specificity, and accuracy for diagnosing sudden sensorineural hearing loss (SSNHL), defined as acute loss of 30 db or more in 3 or more consecutive frequencies, were 100%, 73.3%, and 84.3%, respectively.

Meaning Telemedicine may serve as a reliable primary tool for identifying patients with SSNHL who are in need of an urgent care but are remote from medical resources, especially during this era of COVID-19 pandemic.

Abstract

Importance Developing a telemedicine tool to discriminate between patients who need urgent treatment for sudden sensorineural hearing loss (SSNHL) from those who do not takes on special importance during the COVID-19 pandemic.

Objective To explore the feasibility of a telemedicine model to assist in the evaluation of new-onset unilateral sudden hearing loss (SHL) among patients who do not have access to medical resources, especially during the COVID-19 pandemic.

Design, Setting, and Participants This prospective cohort investigation of a telemedicine model was conducted at a tertiary referral medical center between May 2020 and January 2021, with the interpreting physician blinded to the results of formal audiograms. The study included a consecutive sample of adult patients (aged ≥18 years) referred to the otolaryngology emergency department in our medical center with the chief complaint of new-onset unilateral SHL.

Interventions The telemedicine model comprised 2 sequential steps: a Weber test using the Hum Test and a smartphone-based vibration, and uHear app-based audiometry.

Main Outcomes and Measures Discrimination between patients with and without SSNHL by using the telemedicine model. All diagnoses subsequently confirmed by a formal audiogram.

Results Fifty-one patients with new-onset unilateral SHL participated in the study study (median age, 45 [range, 18-76] years; 28 [54.9%] men). The sensitivity and specificity of the telemedicine model for fulfilling the audiometric criteria of SSNHL (loss of ≥30 dB in ≥3 consecutive frequencies) were 100% (95% CI, 84%-100%) and 73% (95% CI, 54%-88%), respectively. The PPV was 72% (95% CI, 53%-87%), the NPV was 100% (95% CI, 85%-100%), and the accuracy was 84.3% (95% CI, 71%-93%). Although 8 participants had false-positive results, all of them had SSNHL that did not meet the full audiometric criteria.

Conclusions and Relevance The telemedicine model presented in this study for the diagnosis of SSNHL is valid and reliable. It may serve as a primary tool for the discrimination between patients in need of urgent care for SSNHL from those who are not, especially during the COVID-19 pandemic.

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Article Information

Accepted for Publication: October 23, 2021.

Published Online: December 23, 2021. doi:10.1001/jamaoto.2021.3672

Corresponding Author: Shahaf Shilo, MD, Department of Otolaryngology–Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel (shiloshahaf@gmail.com).

Author Contributions: Dr Shilo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Shilo, Ungar, Handzel, Muhanna, Oron.

Acquisition, analysis, or interpretation of data: Shilo, Abu Eta, Shapira, Muhanna, Oron.

Drafting of the manuscript: Shilo, Handzel, Muhanna, Oron.

Critical revision of the manuscript for important intellectual content: Ungar, Handzel, Abu Eta, Shapira, Muhanna, Oron.

Statistical analysis: Shilo, Ungar, Abu Eta, Muhanna, Oron.

Obtained funding: Muhanna.

Administrative, technical, or material support: Shilo, Ungar, Handzel, Shapira, Muhanna.

Supervision: Ungar, Handzel, Abu Eta, Muhanna, Oron.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Esther Eshkol, the institutional medical and scientific copyeditor, is thanked for editorial assistance.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.