Diagnostic Accuracy of Different Bedside Clinical Methods in Evaluation of Peripheral Neuropathy in Patients of Diabetes: Experience at a Tertiary Care Center

Background and Objectives: At present, the gold standard for diagnosis of diabetic peripheral neuropathy is biothesiometry. Sincethe data are sparse comparing the biothesiometry with commonly used bedside tests, we conducted this study to evaluate theclinical accuracy of simple bedside clinical screening tools for evaluation of peripheral neuropathy in patients of diabetes mellitus.Materials and Methods: Atotal of 120 patients with diabetes mellitus referred from the endocrinology department, from August2014 to July 2017 were included in this study. A detailed clinical assessment including diabetic neuropathy symptom (DNS)score, diabetic neuropathy examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, and 10 gSemmes-Weinstein monofilament, and biothesiometry was done in all the subjects.Results: The prevalence of peripheral neuropathy was 36% with biothesiometry. Only 33.33% of patients followed foot carepractices in the study population. Monofilament was the most sensitive and accurate of all the diagnostic tests for the evaluationof peripheral neuropathy in diabetes patients. On statistical analysis correlations observed between the biothesiometry andthe DNE score (r = 0.572, P < 0.00018) and DNS score (r = 0.436, P < 0.0004) and absent tuning fork sensation (r = 0.510;P < 0.0007), monofilament sensation (r = 0.713; P < 0.0002) and ankle reflex (r = 0.456, P = 0.0002) were significant.Interpretation and Conclusions: we concluded that simple bedside tests are useful for diagnosing peripheral neuropathy indiabetes patients including those in whom foot care practices are not followed.

Validation of bedside methods in evaluation of diabetic peripheral neuropathy.

Background & objectives: Vibration perception threshold (VPT) is considered as a gold standard for diagnosis of diabetic peripheral neuropathy. However, the data are sparse comparing the VPT with commonly used bedside modalities. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy in patients with diabetes mellitus. Methods: A total of 1044 patients with diabetes mellitus attending the Diabetes clinic from January 2007 to May 2008, were included in this study. All subjects had a detailed clinical assessment including Diabetic Neuropathy Symptom (DNS) score, Diabetic Neuropathy Examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, 10g Semmes-Weinstein monofilament and vibration perception threshold (VPT). Results: The prevalence of peripheral neuropathy was 34.9 per cent with VPT. Foot care practices were followed by only 214 (20.5%) of the study population. When compared with VPT, ankle reflex was the most sensitive (90.7%) but least specific (37.3%). The tuning fork and monofilament tests respectively had lower sensitivity (62.5 and 62.8%) but better specificity (95.3 and 92.9%) and accuracy (78.9 and 77.9%). Significant correlations were observed between the VPT score and the DNE (r = 0.532, P<0.001) and DNS (r = 0.546, P<0.001) scores and absent tuning fork sensation (r= 0.590; P<0.001), monofilament sensation (r= 0.573; P<0.001) and ankle reflex (r = 0.377, P= 0.01). Interpretation & conclusions: The present findings show that simple bed side tests are useful for assessing peripheral diabetic neuropathy, even in those subjects in whom foot care practices are not followed.

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.

Utilidad clínica de los tests de Rinne y Weber en el diagnóstico de hipoacusia / Clinical usefulness of Rinne and Weber tests for diagnosing hearing loss

Introducción: Los tests de Rinne y Weber son considerados una herramienta diagnóstica importante. Frente a esto nos preguntamos ¿cuál es la sensibilidad, especificidad y utilidad de los tests de Rinne y Weber? Objetivos: 1. Estudiar la sensibilidad y especificidad de los test de Rinne y Weber en el diagnóstico de hipoacusia. 2. Compararla sensibilidad y especificidad de dichos tests realizados por un operador habitual y un operador ocasional. Material y método: Estudio transversal y ciego. Se incluyeron pacientes mayores de 4 años de edad con indicación de audiometría por sospecha de hipoacusia. Todos los pacientes se estudiaron con tests de Rinne y Weber y se compararon con audiometría de tonos puros. Resultados: Se estudiaron 85 pacientes. La sensibilidad del uso combinado de los tests de Rinne y Weber, por operador ocasional, fue 76,32 por ciento y la especificidad 88,37 por ciento. La sensibilidad del uso combinado de los tests de Rinne y Weber por operador habitual fue 75,76 por ciento> y la especificidad 79,31 por ciento. En comparación al operador habitual no se observó diferencias estadísticamente significativas. Conclusión: Los tests de Rinne y Weber representan una herramienta útil en el diagnóstico de hipoacusia.

Introduction: Rinne and Weber tests are considered an important diagnosis tool. The question arises as to what are the tests sensitivity, specificity and usefulness. Aim: 1. To study the sensitivity and specificity of Rinne and Weber tests in diagnosing hearing loss. 2. To compare the sensitivity and specificity of the above mentioned tests when performed by an experienced vs an occasional practitioner. Material and method: 85 patients were studied. Rinne and Weber test combined sensibility, performed by an occasional practitioner, was 76,32 percent>, and the specificity was 79,31 percent. There were no statistically significant differences between experienced and occasional practitioners. Conclusion: Rinne and Weber test represent useful tools for hearing loss diagnosis.