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Audiometric hearing tests were conducted at the Mayo Clinic in Rochester at the beginning of the 1930s. The list price for one of its audiometers at that time was $3,500, which translates into approximately $37,000 in 2003 currency. Physicians and residents in training were responsible for conducting hearing tests in the 1930s and 1940s. In the early 1940s a registered nurse was trained as an audiometrist to assist for some of the audiometric testing. The first "consulting audiologist" at the Mayo Clinic in Rochester was hired in 1949, early in the development of audiology as a profession. Growth in demand for audiologic services for larger numbers of patients and in the variety of services provided to them led to marked increases in personnel, space, and specialization over the years. En la Clínica Mayo en Rochester, se Ilevaron a cabo estudios auditivos desde el inicio de la década de los treintas. El precio de lista, en ese momento, de uno de sus audiómetros fue de $ 3.500, que corresponde en el año 2003 a cerca de $37.000. Los médicos y los residentes en entrenamiento eran responsables de conducir estas pruebas auditivas en los treintas y cuarentas. A inicios de la década de los cuarentas se entrenó una enfermera graduada como audiometrista, para que ayudara en la elaboración de estas evaluaciones audiométricas. El primer "audiólogo consultor" en la Clinica Mayo de Rochester fue contratado en 1949, en etapas tempranas del desarrollo de la audiología como profesión. Un incremento en la demanda de servicios audiológicos para un número mayor de pacientes y un incremento en la variedad de servicios ofrecidos a ellos, Ilevó con los años a un marcado aumento en el personal, en el espacio de trabajo y en la especialización.

Audiometric hearing tests were conducted at the Mayo Clinic in Rochester at the beginning of the 1930s. The list price for one of its audiometers at that time was 3,500 dollars, which translates into approximately 37,000 dollars in 2003 currency. Physicians and residents in training were responsible for conducting hearing tests in the 1930s and 1940s. In the early 1940s a registered nurse was trained as an audiometrist to assist for some of the audiometric testing. The first "consulting audiologist" at the Mayo Clinic in Rochester was hired in 1949, early in the development of audiology as a profession. Growth in demand for audiologic services for larger numbers of patients and in the variety of services provided to them led to marked increases in personnel, space, and specialization over the years.

This study examined the inter-judge and intra-judge reliability of interpreting the presence or absence of averaged evoked responses. There is considerable variability on both of these measures. The only conclusion which can be made based on the data in this study is that the judges used in this study are not able to be reliably objective about the responses. If this conclusion is correct and can be generalized, the procedure as described in this study should be used with extreme caution. It would further appear that the procedure lacks a great deal of objectivity when conducted without specific objective criteria.

The weight of evidence found in the literature and the results of this study lead us to believe that the effect of pregnancy upon the hearing loss due to clinical otosclerosis is significant and real, although variable and largely unpredictable. This effect has often been exaggerated, however. Hearing difficulties during pregnancy have been overlooked too frequently and often have been studied inadequately. Prompt detection and otologic evaluation will allow a complete audiometric follow-up of the earlier pregnancies in otosclerotic women. Patients afflicted with the more advanced stages of otosclerosis must be aided by the otologist in the choice between an operation and a hearing aid. The results in hearing restoration after the one-stage fenestration operation and the variety of procedures performed on the stapes (particularly stapedoplasty techniques) have afforded extraordinarily good results up to now. If the patient is not amenable to surgical treatment, she may benefit greatly from the use of a suitable hearing aid and from lip reading. Thus, with a properly selected device and instruction in the early adjustment period, many persons who have severe loss of hearing are able to lead useful, happy, and efficient lives. In light of past studies, the facts summarized on the foregoing pages, and the possibilities in otosurgery and aural rehabilitation, we find that much reassurance can be offered to otosclerotic women who are anticipating future gestations. Certainly one would find it most difficult to justify a therapeutic abortion or sterilization in cases of otosclerosis complicated by pregnancy.

With the recent development and distribution of hearing aids incorporated into eyeglasses, there has come an automatic reawakening of interest in providing binaural sound amplification for hard of hearing persons. Although the effort to achieve a practical binaural hearing aid has been long and persistent, it is only in the eyeglass models that many disadvantages and problems seem to have been minimized or eradicated. Mere logical reasoning seems basis enough for the thought that binaural hearing is more satisfactory than monaural; and if one were to give total credence to the claims and inferences of certain hearing aid manufacturers, it would seem that every person suffering from a binaural hearing loss should profit from sound amplification received in both ears. In recent months rather impressive testimonials have been appearing in trade journals supported by hearing aid manufacturers and dealers. 1,2,10,13 Among other things, binaural amplification is reputed to achieve the

Experience with patient-controlled audiometers in a clinical setting suggests that group testing can be accomplished satisfactorily with most adult subjects. Some of the findings and a comparison of results obtained with automatic and conventional audiometry are presented as a basis for evaluating this means of auditory screening. Generally, the findings justify the use of automatic screening audiometry as one means of handling large numbers of patients with relative convenience and economy. Certain problems inherent in the procedure appear to make it impractical for some clinical patients.

Extensive data indicate that the loss of hearing acuity observed with increasing age may be attributed to presbycusis or to the effects of exposure to noise. The problem of differentiating between these two causes of hearing loss is complicated by the many variables in exposure and susceptibility to noise.In this discussion, the author reviews methods for measuring noise and detecting susceptibility to noise, the types of acoustic trauma, and criteria for judging noxious noise.With the establishment of programs for conserving hearing, the relative effects of noise and age on hearing should be better understood.

THE management of acute otitis media in children varies widely among clinicians and institutions. Points of disagreement include the advisability of myringotomy, 1-8 the choice of antimicrobial agents, 3,9-13 the effectiveness of antihistamines and decongestants, and the length of treatment. Accurate microbiologic diagnosis is not possible except by needle aspiration of the middle ear cavity through the tympanic membrane, 5,8,14 an obviously impractical approach. It was thus decided to evaluate regimens by means of a series of clinical trials, the results of two of which have already been reported. 15,16 Because of the danger of complicating mastoiditis and meningitis, 3,17-19 we felt that all patients should receive an antimicrobial drug, although we realized that we would thereby probably be treating unnecessarily a number of patients with otitis media related to viral disease. Previous investigations by this group 15,16 indicated that sulfonamides are not as effective as tetracyclines in the management

T HE PROBLEMS attending the failure to hear normally can hardly be understood without some grasp of what normal hearing is like. This understanding must go beyond the physical characteristics of sound and beyond the organic reception of auditory stimuli. It must include an awareness of the psychological and social effects of audition. Apparently it is difficult to establish the concept that hearing may differ not only in degree but also in kind. Every clinician concerned with hearing is familiar with reports that a patient can hear "real well" and yet fails to understand much of what is said to him. Most of us know of persons who literally can hear a pin drop but still have difficulty in oral communication. Such instances, along with observation and study of persons with severe loss of hearing, point to the important fact that deafness brings about a qualitative as well as a quantitative change in the total pattern of sensory perception (1).

To the Editor: We thank Dr. Finerty for his comments. We have reviewed the 29 study cards of those patients who were termed "treatment failures," in none of whom was myringotomy performed because of the continuation of bulging tympanic membranes. Of those who had subsequent audiograms, one patient had a hearing loss of 15 to 20 decibels at a frequency of 4,000 and another had losses of 15 and 20 decibel in his left and right ear, respectively. The remaining children had either normal audiograms or were too young to be tested. The 5-year-old boy who had a 30 decibel hearing loss had originally presented with a draining left ear; two weeks later, the tympanic membrane appeared somewhat dull. At this time, his hearing was thought to be normal clinically, but five days later and again one month later a hearing deficit was present, though inconsistently, as shown by audiogram.

CONTROVERSIES continue regarding the cause of acute otitis media, the necessity to treat certain forms of otitis media, the choice of antibiotics, and the indications for myringotomy. Most of the valid statements have been summarized in our previous studies. 1-3 After careful reconsideration of all arguments, we decided to continue to use antibacterial therapy as the initial step in treatment of acute otitis media. It appeared after our last study that, of the various antibiotics tested by our group, the combination of penicillin and sulfonamide may be superior to tetracycline, but there was no statistically significant difference in the failure rates among patients treated with penicillin alone and those treated with a combination of penicillin and triple sulfonamide at that time. Administration of pseudoephedrine did not influence the outcome of otitis media in any aspect studied. The present study was performed to evaluate further whether the administration of penicillin together with