Improving Ototoxicity Monitoring in Patients with Cystic Fibrosis: A Quality Improvement Study

Introduction: Children with cystic fibrosis (CF) are treated with ototoxic antibiotics to manage respiratory infections. Ototoxic monitoring is recommended but monitoring guidelines are inconsistently applied. Barriers to routine testing include logistics, inefficient protocols, and perceived increased burden to families. A multi-disciplinary protocol was implemented to improve ototoxicity monitoring.

Methods: A quality improvement study was conducted between February 2023 and February 2025. A retrospective chart review was performed to assess audiologic completion before protocol implementation. Based on these findings, a protocol was then established to facilitate annual audiologic testing for patients who were exposed to ototoxic antibiotics. A prospective observational cohort was subsequently evaluated following the protocol implementation. Audiologic testing was performed prior to discharge for inpatients and in conjunction with outpatient CF visits. Families were then asked to complete a survey about their audiologic testing experience and barriers. Demographics, audiologic testing, and sensorineural hearing loss (SNHL) prevalence were compared pre- and post-implementation.

Results: Sixty-eight subjects were included in the pre-implementation cohort, and 64 subjects were in the post-implementation cohort. The cohorts had similar baseline demographics. Following the protocol implementation, audiologic completion rate increased from 57% pre-implementation to 98% post-implementation (P <.001). SNHL detection rate was not significantly different in the post-implementation cohort. Majority of participants reported having a positive experience with the audiologic assessments and visit scheduling. For example, 92% participants agreed or strongly agreed that they felt comfortable with the audiologist performing the hearing tests.

Conclusions: The findings of this study demonstrate a successful implementation of ototoxicity monitoring in a single institution. Studies with diverse populations and institutional resources are needed for broader adoption of the protocol.