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Numerous studies have demonstrated that hearing aids provide significant benefit for a wide range of sensorineural hearing loss, but no carefully controlled, multicenter clinical trials comparing hearing aid efficacy have been conducted.To compare the benefits provided to patients with sensorineural hearing loss by 3 commonly used hearing aid circuits.Double-blind, 3-period, 3-treatment crossover trial conducted from May 1996 to February 1998.Eight audiology laboratories at Department of Veterans Affairs medical centers across the United States.A sample of 360 patients with bilateral sensorineural hearing loss (mean age, 67.2 years; 57% male; 78.6% white).Patients were randomly assigned to 1 of 6 sequences of linear peak clipper (PC), compression limiter (CL), and wide dynamic range compressor (WDRC) hearing aid circuits. All patients wore each of the 3 hearing aids, which were installed in identical casements, for 3 months.Results of tests of speech recognition, sound quality, and subjective hearing aid benefit, administered at baseline and after each 3-month intervention with and without a hearing aid. At the end of the experiment, patients ranked the 3 hearing aid circuits.Each circuit markedly improved speech recognition, with greater improvement observed for soft and conversationally loud speech (all 52-dB and 62-dB conditions, P/=.001). All 3 circuits significantly reduced the frequency of problems encountered in verbal communication. Some test results suggested that CL and WDRC circuits provided a significantly better listening experience than PC circuits in word recognition (P =.002), loudness (P =.003), overall liking (P =.001), aversiveness of environmental sounds (P =.02), and distortion (P =.02). In the rank-order ratings, patients preferred the CL hearing aid circuits more frequently (41.6%) than the WDRC (29.8%) and the PC (28.6%) (P =.001 for CL vs both WDRC and PC).Each circuit provided significant benefit in quiet and noisy listening situations. The CL and WDRC circuits appeared to provide superior benefits compared with the PC, although the differences between them were much less than the differences between the aided vs unaided conditions. JAMA. 2000;284:1806-1813.

This study aimed to test the performance of proposed methods for detecting malingering subjects on computerized dynamic posturography using one subject group in three situations (normal, malingering, vestibular weakness).The study design was a prospective, blinded study.The study was conducted at a university hospital.Volunteer subjects aged 20-59 years of age participated.Computerized dynamic posturography was performed under three situations: best effort, faking vestibular weakness, and transient induced vestibular weakness with bilateral simultaneous caloric irrigation.Measured was identification of situation (normal, malingering, induced vestibular weakness) by each of three detection methods: blinded clinical scoring, a set of formulae, and a set of variables (the latter two methods proposed previously by other investigators).Each method performed well. In three-way discrimination, the formulae and clinical scoring each correctly identified approximately 75% of trials. In two-way discrimination (malingering vs. induced vestibular weakness), the best combination of variables slightly outperformed clinical scoring (0.93 vs. 0.88 ROC [receiver operating characteristic] curve area).Computerized dynamic posturography can distinguish malingering in normal subjects from trials performed with best effort or after binaural simultaneous caloric irrigation. The accuracy of blinded clinical scoring was comparable to that of two objective detection methods.

Cochlear implant surgery by a group of experienced surgeons proceeded without major complications. Computed tomography scans tended to underestimate cochlear obstruction, but a drill-out was infrequently required if the scan was apparently normal.

Dizziness is a common and disabling symptom in primary care practice, especially among the elderly. Though there are many organic causes of dizziness, the results of medical workups are negative in the majority of patients.A total of 75 patients with dizziness who were referred to a community otolaryngology practice received a structured psychiatric diagnostic interview (National Institute of Mental Health Diagnostic Interview Schedule) and questionnaires that assessed psychological distress as well as a complete otologic evaluation, including electronystagmogram. Patients with evidence of a peripheral vestibular disorder were compared with those without such evidence.While psychiatric diagnoses were present in both those with and without evidence of a peripheral vestibular disorder, those without such evidence had a greater mean number of lifetime psychiatric diagnoses as defined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, and specifically, a greater lifetime prevalence of major depression and panic disorder. This group also more frequently met criteria for somatization disorder, had more current and lifetime unexplained medical symptoms, and had more severe current depressive, anxiety, and somatic symptoms.Psychiatric diagnoses are common among patients with dizziness referred for otologic evaluation who do not show evidence of a peripheral vestibular disorder. Specific psychiatric disorders should be part of the differential diagnosis of patients who present with dizziness.

A three-stage method is proposed for allocation of hearing handicap. First, for a given injury or noise exposure period, the percentage of loss allocable for each ear is calculated as a simple ratio of hearing change (after age correction) to final hearing level. Second, final hearing handicap is divided between the two ears using a formula derived from the 1979 AAO-HNS/AMA standard. The percentage of hearing handicap allocable to a given period for each ear is simply the product of that ear's scores from the first two steps.

Noise is an environmental health problem that has not received sufficient attention. Physicians should become knowledgeable about the medical consequences of excessive noise, support legislation to reduce the problem and promote programs aimed at noise control and prevention of hearing loss. Questions about noise and hearing should be incorporated into the medical history, and pure-tone audiometry should be a part of periodic physical evaluations.

Noise-induced hearing loss is a major and entirely preventable public health problem. Effective prevention of this disorder has yet to be achieved in the United States but would improve the overall hearing health of the population more than the treatment of all other otologic disorders combined. Losses that are mild to moderately severe and maximal at 3, 4 or 6 kHz are typical but not pathognomonic. Individual differences in susceptibility are substantial but unpredictable. Hearing conservation programs are now required by the Occupational Safety and Health Administration for almost all employees whose daily exposure to noise exceeds a time-weighted average of 85 dBA (A-weighted sound pressure level). The permitted exposure level is 90 dBA time-weighted average, above which engineering or administrative controls or hearing protectors are required. Workers with lesser exposures (85 to 90 dBA time-weighted average) who have hearing changes must be similarly protected. Many, but not all, elements of required hearing conservation programs have been specified recently by the Occupational Safety and Health Administration. Medical supervision and otologic referral are important components of hearing conservation programs because otologic problems other than noise-induced hearing loss are common in industrial populations. Compensation for noise-induced hearing loss, which is awarded through state workers' compensation boards, as well as certain federal sources, varies widely.

An understanding of vestibular function and a careful history will quickly separate patients with disease of the vestibular system from others. Further history and physical examination, often coupled with audiometric and vestibular function tests, will aid in localizing the lesion to the central or peripheral portions of the system and in determining the affected side. Medical management, which is often nonspecific and involves considerable psychological support, usually suffices.

Clinical features of 44 culture-confirmed cases of diphtheria involving the respiratory tract treated at the University of Washington and affiliated hospitals in Seattle over a five-year period were studied. Of 42 patients treated primarily in Seattle, five (11.9%) died; nonfatal, toxin-induced complications occurred in seven (16.7%). Airway obstruction was the most common cause of death in this series. Diphtheritic membrane (especially in the larynx), dyspnea, and leukocytosis were dire prognostic signs. We urge indirect laryngoscopyin all cases showing membrane formation; tracheotomy should be considered when laryngeal membrane is present. Diphtheria should be suspected in any patient with pharyngitis who has been in contact with endemic areas, especially when pharyngeal membrane is present.

A technique of intracranial facial nerve anastomosis using fenestrated collagen splints was used in eight patients operated upon for acoustic neuroma or glomus temporale tumor. This technique is rapid and simpler than suturing in the cerebellopontine angle. Clinical results are as good as or even better than those obtained with more peripheral facial nerve anastomosis or grafting. An animal study demonstrated no undue histologic reaction to the collagen splints.

Definition of a standard threshold shift (STS) and its use as an early indicator to identify those employees with deteriorating hearing are necessary aspects of hearing conservation programs in industry. STS criteria were evaluated using techniques borrowed from decision theory and signal detection theory to separate audiometric threshold shifts into true-positive and false-positive shifts. The current Occupational Safety and Health Administration definition of a "change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at 2, 3 or 4 kHz in either ear" and the American Academy of Otolaryngology-Head and Neck Surgery recommendation of a "10 dB or greater change for the worse for either the 0.5, 1, 2 kHz pure tone average or the 3, 4, 6 kHz pure tone average, in either ear" were supported. Revision of baselines after an STS occurs is recommended.

Carcinosarcomas are rare tumors of the upper aerodigestive tract, consisting of both carcinomatous and sarcomatous tissue. The larynx and oral cavity are most frequently involved. There has been much controversy regarding the histological nature and clinical course of these tumors. We report a case of carcinosarcoma of the floor of mouth in a 76 year old man who presented with a large pedunculated sublingual mass. There was no evidence of regional or systemic metastatic disease. After local excision, he was followed for one year without evidence of recurrence or metastasis. A review of the literature is presented, with an attempt to clarify clinically relevant aspects of nomenclature, pathogenesis, and clinical course.