Medical home practice algorithm for infants with sensorineural hearing loss

Medical home providers are becoming principle providers in the medical evaluation and management of infants with sensorineural hearing loss (SNHL). Although the medical evaluation of an infant with SNHL can be complex due to the need to consider individual risk indicators as well as the myriad of tests available, a systematic approach to the evaluation process can assist the medical provider in making those decisions. The purpose of this project was to create a medical home practice algorithm for infants with SNHL based on a critical review of the scientific literature.; The resulting algorithm indicated the medical home provider should routinely perform a systematic family and medical history, physical examination, and ophthalmologic screen when an infant with SNHL presents to the medical home. In cases of neonates, cytomegalovirus titers should routinely be performed. Other laboratory studies should be performed only when risk indicators are noted. The medical home should routinely offer connexin 26 full sequence analysis in certain ethnic/racial backgrounds. For other ethnic/racial backgrounds or for infants with specific genetic risk indicators, referrals to clinical geneticists are warranted. For those infants with SNHL and negative connexin 26 results, radiologic studies are valuable. Routine long-term healthcare monitoring by the medical home should be performed with special attention to middle ear monitoring. Finally, routine audiometric and habilitation monitoring should be provided by the audiologist.; Medical algorithms are not meant to replace individual clinical judgement. Individual cases will vary. Parental preferences and concerns should be valued in the decision-making process. Furthermore, individual practitioners will vary in their level of expertise, and routine referrals to specialists for additional assessment may be necessary.