Otologic injuries from airbag deployment.

Airbags became available as an optional passive restraint system in motor vehicles in 1973. The National Highway Traffic Safety Administration mandated placement of driver and right passenger airbags in all passenger vehicles and light trucks beginning in model year 1997. An estimated 2.1 million airbags have been deployed from the late 1980s until the present. There have been several case reports of hearing loss after exposure to airbag deployments in drivers and passengers since 1995. Members of the American Academy of Otolaryngology-Head and Neck Surgery submitted case reports on 71 patients with otologic symptoms after airbag deployment.

Noise level analysis of commercially available toys.

There have been several isolated reports of hearing loss due to noise levels from toys. Guidelines for noise production by toys is regulated by the Voluntary Product Standards PS 72-76: Toy Safety Act of 1969. To determine the current risk of noise induced hearing loss from toys currently on the market, 25 toys were purchased at a national toy store chain and sound levels were measured at distances approximating ear level (2.5 cm) and a child's arm length (25 cm) from the surface of the toy. Testing revealed peak sound levels ranging from 81 to 126 dBA at 2.5 cm and 80 to 115 dBA at 25 cm from the surface of the toy.

Entry of the hearing impaired into the health care system.

The current system of referral of patients complaining of hearing loss usually requires a dual appointment with otolaryngology and audiology. Most of these patients have sensorineural hearing loss for which there is rarely surgical or medical treatment. This study tests the hypothesis that these patients would receive appropriate treatment and that health care dollars would be saved if an audiological assessment could identify those patients who require medical or surgical care. One hundred consecutive patients whose sole complaint was hearing loss were evaluated using audiograms and "hearing abilities questionnaires" by five audiologists using subjective and objective criteria to determine the need for referral to otolaryngology. Audiologists determined the need for referral with an accuracy of 55% and 72% utilizing subjective and objective criteria, respectively. The questionnaire was found to be of little value. Audiologists may be able to function as the entry point into the health care system for patients complaining of hearing loss. We are encouraged by the results of this preliminary study, but improvement in the system by which audiologists detect disease is necessary.

Abnormal coagulation profiles in tonsillectomy and adenoidectomy patients.

Preoperative coagulation profile screening is routinely performed in otolaryngology before tonsillectomy and adenoidectomy surgery in the United States. Recently there has been controversy as to whether this routine testing is necessary. To evaluate the need for this testing, we reviewed a series of patients with particular attention to abnormal coagulation profiles. Of 91 consecutive patients undergoing tonsillectomy, adenoidectomy, or both, four had abnormal preoperative coagulation profiles. Of these patients, one had von Willebrand disease, one had hypofibrinoginemia, and two had a transient acquired lupus-like anticoagulant. The latter condition, which causes a temporary prolongation of the activated partial thromboplastin time, is discussed in detail along with a review of the pertinent literature. We conclude that coagulopathies occur frequently enough to justify preoperative screening even in the absence of a positive history.

Functional endoscopic sinus surgery: morbidity and early results.

Functional endoscopic sinus surgery is a new alternative to conventional sinus surgery as a means of managing recalcitrant sinus disease. This approach to sinus pathology focuses on the importance of the functional ostiomeatal complex and anterior ethmoid sinuses in the pathogenesis of sinus disease. In an effort to assess the morbidity and initial results of this procedure, 85 cases were reviewed. A total of 82% of the patients had bilateral maxillary and ethmoid sinusitis, and 45% had pansinusitis, frequently associated with allergic rhinitis (56%) and nasal polyps (58%). A total of 82% of the patients were operated on as outpatients under local anesthesia. There were no major complications associated with the surgery and minor complications were rare. Disease control was achieved in 88% of patients with short-term follow-up.

Effect of renal failure and dialysis on the serum concentration of the aminoglycoside amikacin.

Serum and dialysate levels of amikacin were determined at appropriate intervals after a 300-mg intravenous dose as a continuous infusion in six patients with end-stage renal failure undergoing hemodialysis and in three patients on peritoneal dialysis. The mean serum half-life of amikacin was 3.75 h during (or after) hemodialysis and 29 h during (or after) peritoneal dialysis. Although not on hemodialysis in the same six patients, the serum half-life was 28 h. The results indicate that the maintenance dose of amikacin should be markedly decreased in patients with severe renal failure even if they are treated with peritoneal dialysis, and that serial serum antibiotic concentrations are essential to prevent cumulative toxicity of the drug.

Effects of renal failure and dialysis on cefazolin pharmacokinetics.

Serum and urinary levels of cefazolin were determined after a 500-mg parenteral dose in eight azotemic volunteers. The mean peak serum concentration was 1.5 to 5 times the levels obtained in nonazotemic patients. The serum half-life of cefazolin was increased significantly. In patients on dialysis, the mean serum half-life of cefazolin was 4.05 h during (or after) hemodialysis, and 32.1 h during (or after) peritoneal dialysis. There was a significant decrease in cefazolin removal when dialysate flow or membrane surface area of the dialyzer were decreased. It was also shown that one circuit through the dialysis unit caused measurable decrease in cefazolin concentration. These data and previously published reports suggest: (i) the maintenance dose of cefazolin can be decreased in azotemic patients; (ii) patients on hemodialysis will require an additional half dose after dialysis because of efficient removal during hemodialysis; and (iii) patients on peritoneal dialysis do not require an extra dose.