8 Medical Red Flags (USDA Mandates)

Question 1

Red Flag #1

Answer 1

Visible deformity in the outer ear.

Question 2

Red Flag #2

Answer 2

visible evidence of cerumen impaction or significant accumulation or lodged foreign body within the ear canal.

Question 2

Red Flag #3

Answer 2

History with active drainage (oterrhea) within 90 days.

Question 3

Red Flag #4

Answer 3

History of sudden onset of hearing loss within 90 days.

Question 4

Red Flag #5

Answer 4

Acute or chronic symptoms of dizziness.

Question 5

Red Flag #6

Answer 5

Onset of monaural hearing loss of a duration of 90 days or less

Question 6

Red Flag #7

Answer 6

Pain or discomfort within the ear.

Question 7

Red Flag #8

Answer 7

A gap of more than 15 dB between air conduction and bone conduction scores at 500 Hz, 1000 Hz, and 2000 Hz.

Question 8

What timeline is “history” defined as?

Answer 8

Occurring at anytime in the past.

Question 9

What is “acute” defined as?

Answer 9

Has happened once or twice before.

Question 10

Importance of red flag #1?

Answer 10

Medical issue that may need to be looked further into by an ENT Physician, can present problems during hearing tests with possible occlusion caused by deformity, as well as mold fitting and masking issues. Better to let a further trained physician to deal with tests and fittings.

Question 11

Importance of red flag #2?

Answer 11

Depends on state regulations regarding the removal of cerumen, but in general, it is very easy to damage the ear canal and tympanic membrane while cleaning out impactions, so it is best to leave it up to a medical professional trained on the removal of foreign objects/ear wax.

Question 12

Importance of red flag #4?

Answer 12

Medical emergency that needs treatment as soon as possible, refer to ENT immediately.

Question 12

Importance of red flag #3?

Answer 12

Most likely the cause of an ear infection of some sort and should be treated with medication by the proper physician.

Question 12

Importance of red flag #5?

Answer 12

Can be a sign of Meniere’s disease or other underlying problems and should be treated by ENT physician.

Question 12

Importance of red flag #6?

Answer 12

Similar to red flag #5, this is often a sign of other underlying medical issues that can only be treated by a physician.

Question 13

Importance of red flag #7?

Answer 13

Not something that a Hearing Aid Dispenser can treat, and it may affect the process of testing and fitting hearing aids, so it is best to see a physician and get their approval before continuing the process.

Question 14

Importance of red flag #8?

Answer 14

This means there is an underlying issue that only a physician can further look into and diagnose.

Question 15

What do you do when any of the 8 red flags present themselves?

Answer 15

If any of the 8 red flags occur, referral to a physician is mandated, preferably to a physician specializing in diseases of the ear, where the issue may often be resolved with medical and/or surgical intervention.

Question 16

What is the 3+2+3 rule?

Answer 16

The first number, ‘3’, relates to three issues related to the outer ear: (1) Deformity of the ear, (2) History of active drainage, and (3) Cerumen or foreign body in the canal.

Numbers 4 and 5 (the two ‘2′ middle numbers of the system) relate to issues in the middle ear and vestibular mechanism. Number 4 asks about any pain or discomfort associated with the hearing problem, and number 5 asks if the patient has acute or chronic dizziness.

The final number of the system, ‘3’, relates to three bits of information that can be taken from the audiogram and/or through inquiry. Number six calls attention to an air/bone gap. If equal to or greater than 15 dB at 500, 1000, and 2000 Hz, the patient is to be referred to a physician. Number seven alerts the clinician to watch for sudden or rapidly-progressive hearing loss, and number eight seeks to determine if the hearing loss is sudden, and unilateral.

Infographic shown here:
https://hearinghealthmatters.org/waynesworld/2018/hearing-referral-eight-red-flags/