Comparison of techniques for identification of peripheral vestibular nystagmus.

OBJECTIVE: To determine the best clinical method for identifying peripheral vestibular nystagmus, by comparing eye movement examination with optic fixation, and with fixation removed using Frenzel's glasses, infra-red video-Frenzel's goggles or an ophthalmoscope, with results of electronystagmography. METHOD: One hundred patients referred for electronystagmography from the audiovestibular medicine clinic at Queen Alexandra Hospital, Portsmouth, were examined immediately before undergoing electronystagmography. RESULTS: Video-Frenzel's goggles were highly effective at detecting peripheral vestibular nystagmus, with a sensitivity of 85 per cent (95 per cent confidence interval, 62.1-96.8 per cent) and a specificity of 65 per cent (53.5-75.3 per cent), compared with electronystagmography. Ophthalmoscopy had comparable sensitivity to Frenzel's glasses (used in the dark), i.e. 26.3 per cent (9.1-51.2 per cent) compared with 31.6 per cent (12.6-56.6 per cent), respectively. Frenzel's glasses as normally used in ENT clinics (i.e. in dim lighting) were ineffective, with a sensitivity of just 10 per cent (1.2-31.7 per cent). CONCLUSION: Video-Frenzel's goggles should be used in all clinics with substantial numbers of balance-impaired patients. Traditional Frenzel's glasses have no place in clinical practice unless formal black-out facilities are available.

Orthopaedic theatre noise: a potential hazard to patients.

Potentially hazardous noise levels are generated in the course of major orthopaedic surgery. The risk to staff is probably real but very small. We used a sound level meter to record maximum and mean levels and found peak values which exceeded 100 dB(A). If sustained, there is a possibility of significant inner ear damage and perhaps permanent troublesome tinnitus, especially among elderly and already hearing-impaired patients. This could be eliminated by the use of ear defenders or disposable earplugs.