The use of transient evoked otoacoustic emissions as a hearing screen following grommet insertion.

OBJECTIVE: This study aimed to evaluate the sensitivity of transient evoked otoacoustic emission testing as a screening tool for hearing loss in children, after grommet insertion. METHOD: A prospective study was conducted of 48 children (91 ears) aged three to 16 years who had undergone grommet insertion for glue ear. At post-operative review, pure tone audiometry was performed followed by transient evoked otoacoustic emission testing. Outcomes for both tests, in each ear, were compared. RESULTS: The pure tone audiometry threshold was ≤ 20 dB in 85 ears (93.4 per cent), 25 dB in two ears (2.2 per cent) and ≥ 30 dB in four ears (4.4 per cent). Transient evoked otoacoustic emissions were detected in 69 ears (75.8 per cent). The sensitivity of transient evoked otoacoustic emission testing for detecting hearing loss was 100 per cent for ≥ 30 dB loss but only 66.7 per cent for ≥ 25 dB loss. CONCLUSION: Transient evoked otoacoustic emission testing offers a sensitive means of detecting hearing loss of ≥ 30 dB following grommet insertion in children. However, the use of such testing as a screening tool may miss some cases of mild hearing loss.

A cost effective screening protocol for vestibular schwannoma in the late 90s.

Magnetic resonance imaging (MRI) is the imaging modality of choice in diagnosing vestibular schwannoma (VS). Perceived high costs have prevented clinicians from using it as a screening investigation, although MR scanners are now widely available in the United Kingdom. In a retrospective study, the clinical records of all the patients who presented to the ENT department of Taunton and Somerset NHS Trust with suspected symptoms of VS during the year 1994 were analysed. The cost of confirming or refuting the diagnosis of VS in each patient ranged from 220.72 pounds to 580.31 pounds depending on the number of hospital visits and investigations performed. This study shows that the routine use of MR scanning for detection of VS is cost effective and more effective than the use of conventional tests.

The Gamma Loop: a model of glomerular hemodynamics. Part II.

The "Gamma Loop" Part I compared a model of rubber tubing to the architecture of the glomerulus with emphasis placed on the observed relationship between the position of the outflow resistance clamp and the perfusion of the loop (1, 2). Part II describes the pressures observed in the different parts of the loop, as well as the effect of another outflow branch which imitates "filtration".

Embryonal rhabdomyosarcoma of the ear: a review of the literature and case history.

Approximately 50 per cent of all rhabdomyosarcomas in children occur in the head and neck region with the orbit, nasopharynx and ear in order of descending frequency. Embryonal rhabdomyosarcoma is the commonest malignant tumour of the aural region in childhood and its clinical course is usually rapidly fatal, with extensive local disease and or distant metastases (Dehner and Chen, 1978). Other malignant tumours that can occur in children include melanoma and other mesenchymal tumours, including undifferentiated sarcoma, fibrosarcoma, osteogenic sarcomas and Ewing sarcoma. Secondary extension may occur from a meningioma. Osseous disorders of the temporal bone, such as eosinophilic granuloma and Hand-Schüller-Christian disease, should be included as a differential diagnosis (Lewis, 1979).