(863) National vestibular testing utilization trends following a Ménière's Disease CPG publication

Introduction: In April 2020, the American Academy of Otolaryngology–Head and Neck Surgery published a Ménière’s Disease clinical practice guideline (CPG) recommending against vestibular testing to establish diagnosis. This study evaluated national vestibular testing utilization trends in relation to guideline publication using an interrupted time series analysis (ITSA).

Methods: The Reg-entSM Clinical Data Registry was queried for adult patients diagnosed with Ménière’s Disease between January 2015 and November 2025. The primary outcome was the percentage of newly diagnosed patients who underwent vestibular testing within 180 days prior to diagnosis. ITSA assessed changes in level and trend between pre- (January 2015–March 2020) and post-guideline (April 2020–November 2025) periods. A sensitivity analysis excluding 2020–2021 was performed to account for COVID-19–related disruptions.

Results: In the full ITSA, vestibular testing was declining by 0.07 percentage points per month prior to guideline publication (p < 0.001). At publication, there was an immediate decrease of 1.05 percentage points (p < 0.001). Post-publication, testing increased by 0.07 percentage points per month relative to the pre-guideline trend (p < 0.001). In the sensitivity analysis excluding 2020–2021, the pre-guideline decline persisted (−0.04 percentage points/month, p=0.014), but post-publication level and slope changes were no longer statistically significant.

Conclusions: After accounting for pandemic-related disruptions, there was no significant change in vestibular testing utilization following CPG publication. These findings highlight challenges in guideline dissemination during periods of systemic disruption and underscore the need for implementation strategies, such as automated clinical decision support, to promote guideline uptake.