title: The importance of audiologic red flags in patient management decisions.
abstract: BACKGROUND
  It is essential that nonbenign forms of hearing impairment are recognized and addressed before audiological management is entertained.
  
  
  OBJECTIVE
  To present an illustrative case and focused literature review of early red flag indicators for retrocochlear impairment, as might be discerned from a patient's history or physical examination.
  
  
  RESULTS
  The presenting history and clinical course of a female patient with fatal adenocarcinoma presenting as a suspected retrocochlear mass is reviewed over the last four months of her life. Clinical signs, symptoms and test results pointing to the diagnosis of "acoustic neuroma" and then "metastatic neoplasm" are reviewed along with selected supporting reference literature. The ambiguous clinical pictures at various points in her history are analyzed, with an effort to point out how early audiological decisions may significantly impact patient's overall health.
  
  
  CONCLUSIONS
  Clear communication with primary care physicians, vigilance when audiological results are ambiguous for active disease, and pre-established referral relationships with practitioners in the neurologic and otologic disciplines are stressed as important requirements for audiologists who serve as entry points into hearing healthcare.
authors.affiliation: Audiology Section, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, USA. Zapala.David@mayo.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Zapala
authors.forename: Kathryn
authors.initials: K
authors.lastname: Shaughnessy
authors.forename: Jill
authors.initials: J
authors.lastname: Buckingham
authors.forename: David B
authors.initials: DB
authors.lastname: Hawkins
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D001301:Audiometry, Pure-Tone; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D002530:Cerebellopontine Angle / Q000473:pathology; D003299:Cooperative Behavior; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000473:pathology; D010348:Patient Care Team; D012017:Referral and Consultation; D012181:Retrocochlear Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014591:Uterine Diseases / Q000175:diagnosis* / Q000473:pathology