Expert assessment of medical and organizational care for children with congenital ear malformations in the Republic of Kazakhstan: The RAND/UCLA appropriateness method

А.А. Имангалиева, Dina Galymkyzy Kussainova, Akzhan Alimbek, Nurbol Kazybayev, Islam Kamalov, Ulpan Kyrgauyl, Adil Shakaraliyev

2026

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DOI 10.1016/j.amjoto.2026.104964
Data confidence 70 medium
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Abstract

Congenital auditory anomalies are serious conditions ranging from mild hearing loss to complete deafness, with associated speech impairment, social limitations, and disability. Our aim was to evaluate the appropriateness of medical and organizational care interventions for children with congenital ear malformations (microtia and aural atresia) in the Republic of Kazakhstan, using the RAND/UCLA Appropriateness Method. METHODS: A nine-member multidisciplinary expert panel (otorhinolaryngologists, audiologists, pediatricians, and otologic surgeons) rated 93 diagnostic, therapeutic, and rehabilitation interventions using a structured 9-point appropriateness scale across two rounds of evaluation. Consensus was defined as a numerical IQR (Q3-Q1) ≤2 score points combined with ≥75% of ratings within the same category. Appropriateness categories were defined as: Appropriate (median 7-9), Uncertain (4-6), and Inappropriate (1-3). RESULTS: Of 93 rated interventions, 43 (46%) reached consensus as Appropriate, 45 (48%) were classified as Uncertain, and 5 (5%) as Inappropriate. Highest appropriateness was assigned to multidisciplinary diagnostic consultations (ENT specialist, audiologist, otologic surgeon) and imaging (high-resolution CT of the temporal bones, MRI). For bilateral aural atresia, bone conduction devices were rated as Appropriate (mean 7.55-7.66). Non-intervention approaches received the lowest ratings (mean 1.11-3.00), indicating strong expert consensus against expectant management. Key organizational barriers were included as explicitly rated items in the questionnaire (items 85-93, Section 4-5 of Appendix A). Delayed or absent patient registration and follow-up (item 86, mean 8.00, median 8, Appropriate) and inadequacies in regulatory frameworks (item 87, mean 7.22, median 7, Appropriate†) were among the highest-rated organizational items, while insufficient funding (item 88, mean 6.22, median 6, Uncertain without consensus) did not reach consensus. CONCLUSION: This first application of the RAND/UCLA method in Kazakhstan to evaluate care for children with congenital ear malformations identified clear areas of expert consensus and uncertainty. The results support the development of multidisciplinary care pathways and targeted rehabilitation policies. Findings represent structured expert opinion from nine specialist panelists in Kazakhstan and should not be interpreted as evidence of clinical effectiveness, cost-effectiveness, or national representativeness.