Department of Defense Medical Examination Review Board Audiogram Screening Comparative Analysis

Area of Science:

• Audiology
• Military Medicine
• Quality Improvement

Background:

• The Department of Defense Medical Examination Review Board (DoDMERB) uses screening audiograms to assess military officer candidates' hearing.
• High disqualification rates from screening audiograms raised concerns about their accuracy and impact on qualified candidates.

Purpose of the Study:

• To evaluate the accuracy of screening audiograms compared to reference-standard audiometry.
• To investigate the relationship between disqualification status and hearing thresholds.
• To inform improvements in the military medical screening process.

Main Methods:

• A quality improvement project analyzed 134 candidates' audiograms from 2017-2019.
• Compared screening audiogram results with reference-standard audiometry.
• Utilized Bland-Altman analysis to assess agreement between the two testing methods.

Main Results:

• Screening audiograms showed mean thresholds twice as high as reference-standard tests, especially at lower frequencies.
• 84% of candidates were incorrectly disqualified by screening audiograms.
• Significant disagreement was found between screening and reference-standard audiometry.

Conclusions:

• The study highlighted inaccuracies in DoDMERB's screening audiograms, leading to a policy change mandating reference-standard audiometry for all failed screenings.
• This change ensures more accurate assessments, reduces candidate burden, and prevents erroneous disqualifications.
• Improving testing facility noise specifications is a practical enhancement for the screening process.