Position Statement: Red Flags-Warning of Ear Disease
Hearing loss and balance disorders are medical conditions. Only licensed physicians with a medical school degree and medical training (MD or DO) may diagnose and direct the management of diseases and medical disorders. A full history and physical examination by a physician (preferably an ENT physician (Otolaryngologist) with specialty training in disorders of the ear) to determine the accurate medical diagnosis and appropriate medical/surgical treatment for hearing loss and balance disorders are indicated for patients with the following “red flags”:
1. Hearing loss with a positive history of ear infections, noise exposure, familial hearing loss, TB, syphilis, HIV, Meniere’s disease, autoimmune disorder, ototoxic medication use, otosclerosis, von Recklinghausen’s neurofibromatosis, Paget’s disease of bone, ear or head trauma related to onset.
2. History of pain, active drainage, or bleeding from an ear.
3. Sudden onset or rapidly progressive hearing loss.
4. Acute, chronic, or recurrent episodes of dizziness.
5. Evidence of congenital or traumatic deformity of the ear.
6. Visualization of blood, pus, cerumen plug, foreign body, or other material in the ear canal.
7. An unexplained conductive hearing loss or abnormal tympanogram.
8. Unilateral or asymmetric hearing loss (a difference of greater than 15 dB Pure Tone Average between ears); or bilateral hearing loss > 30 dB.
9. Unilateral or pulsatile tinnitus.
10. Unilateral or asymmetrically poor speech discrimination scores (a difference of greater than 15% between ears); or bilateral speech discrimination scores <80%.
The red flags do not include all indications for a medical referral and are not intended to replace clinical judgment in determining the need for consultation with an ENT physician (Otolaryngologist).
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.