Delayed diagnosis of large cerebello-pontine angle tumors, despite hearing conservation training

Recently, at the National Naval Medical Center in Bethesda, Maryland, we have encountered several patients with large cerebello-pontine angle tumors. All were active duty and had evaded the military's stringent hearing screening program until the tumors were of life-threatening size. Early detection of these tumors can reduce overall morbidity and improve the patient's chances of returning to a normal lifestyle. We have analyzed each of these cases and discovered weaknesses in the program. The primary difficulty was in accurately following the algorithms set forth by military regulations. To that end we recommend: (1) establishing a cutoff for identification of those who should be evaluated after they obtain their enlistment/annual physical examinations; (2) specific training for hearing conservation program managers in the algorithms for hearing screening; (3) establishment of specific guidelines for primary care physicians for further evaluation of abnormal audiograms; and (4) reevaluation of form DD 2216.