Congenital oval window aplasia: An unusual cause of conductive hearing loss in an adult

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To  report  a  case  of  congenital  oval  window  aplasia  (COWA)  in  a  Filipino  adult presenting   with      unilateral   maximal   conductive   hearing   loss   and   discuss   the   diagnostic considerations, pathophysiology and management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Public Referral Center<br /><strong>Patient:</strong> One <br /><strong>RESULTS:</strong> Audiometric evaluation showed a maximal unilateral left conductive hearing loss. High resolution temporal bone CT showed absence of the oval window on the left along with facial and stapes  abnormalities.    Exploratory  tympanotomy  showed  an  aberrant  facial  nerve,  monopodal and  abnormally  located  stapes  and  absent  oval  window. Postoperative  hearing  gain  achieved after a neo-oval window and Schuknecht piston wire prosthesis remained stable over two years.<br /><strong>CONCLUSION:</strong> A congenital minor ear anomaly classified as Cremers Class 4a in which a congenital oval  window  aplasia  was  associated  with  an  aberrant  facial  nerve  anomaly  and  a  monopodal stapes is reported. Recent literature supported the view that congenital oval window aplasia can in selected cases be amenable to various surgical approaches and a stable postoperative hearing gain is achievable in the long term.</p>

Preliminary results of static tests of balance among asymptomatic normal Filipino adult volunteers

OBJECTIVES: To determine the effect of age, ex and body index on selected static tests of balance and to generate referance normtive data among the different population groups. METHODS: In this cross-sectional study, 100 asymptomatic normal adult Filipino volunteers, aged 20 to 69 years were tasked to perform selected static balance tests. These tests included classic Romberg (CR), Romberg with Jendrassik (RJ) maneuver, tandem Romberg (TR), standing on foam with feet apart (SOFFA), standing on foam with feet together (SOFFT) and standing on one leg (SOL). All tests were done with eyes opened (EO) followed by eyes closed (EC) for 30 seconds each. Volunteers were grouped into age groups by decades, normative values were obtained and effects of age, sex and body mass index, if any, on performance of the various tests were determined. RESULTS: All volunteers were able to do the CR and RJ maneuver for 30 seconds. All were able to perform for 30 seconds the TREO, SOFFA EO and SOFFT EO procedures. Some volunteers were unable to complete the TREC, SOFFA EC, SOFFT EC, SOL EO and SOL EC procedures. The mean performance duration values for TREC, SOFFA EC, SOFFT EC, SOL EO AND SOL EC were significantly negatively correlated with age. Although majority of tests were negatively correlated with body mass index, the correlations were not statistically significant. CONCLUSION: Age significantly affects selected static balance performance whereas sex and body mass index do not significantly affect selected static balance performance. The normative values generated in this study are inconclusive because of inadequate sample size, particularly in the older age group. The results, however, showed the potential value of the 5th percentile as a normative norm in systematically assessing the involvement of the vesticular, visual and proprioceptive organs i balance function.

Training of nurses in ear examination and hearing screening in the school setting (Phase II): A cross-sectional study

OBJECTIVES:To determine the agreement between 1) ear examination findings of the otorhinolaryngologist using an otoscope and trained elementary school nurses using a penlight, 2) hearing screening findings of the otorhinolaryngologist and elementary school nurses, both using the Philippine National Ear Institute (PNEI) Method of 512 Hz Tuning Fork Test (TFT) and 3) PNEI Method of 512 Hz TFT findings and screening audiometry findings.METHODS:In this continuing study, nurses residing in the venue of the study, and previously trained in ear examination using a penlight and hearing screening using the PNEI 512 Hz TFT, conducted these in school children who attended the hearing screening and medical mission. Otoscopy, PNEI Method of 512 Hz TFT, and screening audiometry were then conducted on the children by the otolaryngologist. The nurses and the otolaryngologist performed independent and blinded assessments.RESULTS:Eighteen nurses and ninety children participated in the study. Data subjected to Kappa statistics showed good agreement between nurses and otorhinolaryngologist's findings in the examination of the external canal and tympanic membrane and in PNEI Method of 512 Hz TFTs, and between the PNEI Method of 512 Hz TFT and screening audiometry.CONCLUSION:PNEI methods of penlight ear examination and 512 Hz TFT may be effective tools for early detection of common ear conditions and hearing screening in Filipino school children. These may be conducted in the school setting not only by otorhinolaryngologists but also by adequately trained school nurses.

Training of nurses in ear examination and hearing screening in the school setting.

The objectives of this study were to determine the agreement between the ear examination findings of the otorhinolaryngologist (trainer) and the elementary school nurse (trainee) after training with the use of a penlight and to determine the mean sound pressure level (SPL) produced by school nurses as a standard parameter for hearing screening using a 512 tuning fork after training on tuning fork testing by the otorhinolaryngologist. Training workshops in ear examination using a penlight and hearing screening using a 512 tuning fork were conducted for school nurses. Data for assessment of ear examination skills and production of SPL were collected by questionnaire and observation of performance. Kappa statistics were used to assess agreement between trainees' and trainer's responses. Mean and standard deviation were determined for the assessment of the SPL produced. Results showed an excellent agreement between the school nurses' and otorhinolaryngologist's observations on ear examination. These included observations of the ear canal, visualization of the tympanic membrane and identification of unusual findings such as wax and discharge. The majority of nurses responded positively in terms of the ease and confidence in performance of the procedure. Regarding tuning fork testing, the nurses were able to produce significant SPL. The mean SPL produced by the nurses using a 512 tuning fork was 56.316 dB.