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A Tool to Help Consumers Assess Risk for Ear Disease

Klyn, Niall A. M.1; Kleindienst Robler, Samantha2,3; Bogle, Jamie2; Alfakir, Razan4; Nielsen, Donald W.5; Griffith, James W.6; Carlson, Deborah L.7; Lundy, Larry4; Dhar, Sumitrajit1,8; Zapala, David A.4

doi: 10.1097/AUD.0000000000000731

This article introduces the Consumer Ear Disease Risk Assessment (CEDRA) tool. CEDRA is a brief questionnaire designed to screen for targeted ear diseases. It offers an opportunity for consumers to self-screen for disease before seeking a hearing device and may be used by clinicians to help their patients decide the appropriate path to follow in hearing healthcare. Here we provide highlights of previously published validation in the context of a more thorough description of CEDRA’s development and implementation. CEDRA’s sensitivity and specificity, using a cut-off score of 4 or higher, was 90% and 72%, respectively, relative to neurotologist diagnoses in the initial training sample used to create the scoring algorithm (n = 246). On a smaller independent test sample (n = 61), CEDRA’s sensitivity and specificity were 76% and 80%, respectively. CEDRA has readability levels similar to many other patient-oriented questionnaires in hearing healthcare, and informal reports from pilot CEDRA-providers indicate that the majority of patients can complete it in less than 10 min. As the hearing healthcare landscape changes and provider intercession is no longer mandated, CEDRA provides a measure of safety without creating a barrier to access.

1Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA

2Division of Audiology, Mayo Clinic, Scottsdale, Arizona, USA

3Department of Audiology, Norton Sound Health Corporation, Nome, Alaska, USA

4Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, Florida, USA

5Don Nielsen Consulting, LLC, Dublin, Ohio, USA

6Department of Medical Social Science, Northwestern University, Chicago, Illinois, USA

7Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA

8The Hugh Knowles Center, Northwestern University, Evanston, Illinois, USA.

Received May 11, 2018; accepted February 16, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

All authors contributed equally to this work. D. Z., S. R., S. D., D. N., L. L., and J. G. contributed to the initial data collection and analysis. N.K. wrote the initial draft of the article. All authors reviewed, edited, and approved the final article.

Conflicts of interest: The authors have no conflicts of interest to disclose.

Address for correspondence: Niall Klyn, Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Dr, Evanston, IL 60208, USA. E-mail:

Online date: April 02, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.