Red Flags-Warning of Ear Disease

Hearing loss and balance disorders are medical conditions.  Only licensed physicians with medical training may diagnose and direct the management of disease and medical disorders.  A full history and physical examination by a physician (preferably a physician specially trained 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 familial hearing loss, TB, syphilis, HIV, Meniere’s disease, autoimmune disorder, otosclerosis, von Recklinghausen’s neurofibromatosis, Paget’s disease of bone, 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, or foreign body in the ear canal.
  7. Conductive hearing loss or abnormal tympanogram.
  8. Unilateral or asymmetric hearing loss; or bilateral hearing loss > 80 dB.
  9. Unilateral or pulsatile tinnitus.
  10. Unilateral or asymmetrically poor speech discrimination scores.

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 otolaryngologist.

Approved 9-12-02


Important Disclaimer Notice

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. 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.

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