A retrospective estimate of ear disease detection using the “red flags” in a clinical sample

Niall A.M. Klyn, Samantha Kleindienst Robler, Razan Alfakir, Donald W. Nielsen, James W. Griffith, Deborah L. Carlson, Larry Lundy, Sumitrajit Dhar, David A. Zapala

Research output: Contribution to journalArticlepeer-review


Objectives: The purpose of this study was to evaluate the specificity and sensitivity of two red flag protocols in detecting ear diseases associated with changes in hearing. Design: The presence of red-flag symptoms was determined in a chart review of 307 adult patients from the Mayo Clinic Florida Departments of Otorhinolaryngology and Audiology. Participants formed a convenience sample recruited for a separate study. Neurotologist diagnosis was the criterion for comparisons. Results: Of the 251 patient files retained for analysis, 191 had one or more targeted diseases and 60 had age- or noise-related hearing loss. Food and Drug Administration red flags sensitivity was 91% (confidence interval [CI], 86 to 95%) and specificity was 72% (CI, 59 to 83%). American Academy of Otolaryngology-Head and Neck Surgery red flags sensitivity was 98% (CI, 95 to 99%) and specificity was 20% (CI, 11 to 32%). Conclusions: Stakeholders must determine which diseases are meaningful contraindications for hearing aid use and whether these red-flag protocols have acceptable levels of sensitivity and specificity. As direct-to-consumer models of hearing devices increase, a disease detection method that does not require provider intercession would be useful.

Original languageEnglish (US)
Pages (from-to)1035-1038
Number of pages4
JournalEar and Hearing
Issue number5
StatePublished - 2018
Externally publishedYes


  • Ear diseases
  • Medical evaluation
  • Red flags

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing


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