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Global Utilization of Ototoxic Medications

This survey is designed to gather data on the actual utilization of ototoxic medications (aminoglycoside and chemotherapy agents) in a variety of global healthcare settings. Although this data is critical to estimate the impact of these medications on hearing loss, we recognize that some of these questions relate to conditions and medications that you might not directly treat or prescribe. If necessary, we ask that you consult with treating physicians in your home institutions. Thank you for participating in this survey. 

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* 1. What is your age

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* 2. What is your profession and training?

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* 3. In what country do you work?

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* 4. In what type of clinical setting(s) do you work (check all that apply)?

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* 5. What is the MOST COMMON aminoglycoside used for systemic therapy (excluding ototopical) in the hospital / clinics in your community?

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* 6. Please estimate the percentage of all systemic AMINOGLYCOSIDE prescriptions that are prescribed for the following age groups in your hospital / clinics or community (total of all age groups should equal 100%).

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* 7. How frequently do the hospitals / clinics in your community or region routinely monitor serum levels for patients being treated with aminoglycosides?

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* 8. How strongly do you agree that aminoglycoside ototoxicity (i.e., drug-induced hearing loss) is a serious problem in your community / region?

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* 9. Please estimate the percentage of patients using aminoglycosides that receive these drugs without a physician’s prescription in your community or region:

0 100
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i We adjusted the number you entered based on the slider’s scale.

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* 10. Which ototoxic drugs do the hospitals/clinics in your community/region provide audiological monitoring for potential ototoxicity?

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* 11.  Do referral pathways exist from the departments of oncology, internal medicine, or infectious disease in which providers can refer patients treated with ototoxic drugs for hearing evaluations? If yes, please briefly describe referral pathway(s).

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* 12. Are there national or center-specific guidelines that you use for ototoxicity monitoring?

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* 13. What audiological tests are used to monitor for Cisplatin Ototoxicity in your hospital / clinic? Check all that apply.

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* 14. What audiological tests are used to monitor for Aminoglycoside Ototoxicity in your hospital / clinic? Check all that apply.

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* 15. What percentage of patients receiving Cisplatin chemotherapy receive audiological monitoring for cisplatin  ototoxicity in your hospital / clinic? 

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i We adjusted the number you entered based on the slider’s scale.

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* 16. What percentage of patients receiving aminoglycoside medications receive audiological monitoring for aminoglycoside ototoxicity in your hospital / clinic?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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* 17. What do you believe to be the most relevant barriers to proper ototoxicity monitoring in your center? Please rank the following.

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* 18. What are the other barriers to proper ototoxicity monitoring in your hospital / clinic or community?

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