Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: < 20 dB ABG at 500 Hz predicts absence of ossicular discontinuity while > 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of <30 dB at 500 Hz and <20 dB at 1 KHz decrease probability of ossicular discontinuity from 32.97 percent to 2.54 percent. Combination of air bone gaps of >50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97 percent to 85.9 percent. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. (Author)
AUDIOMETRY AUDIOMETRY ; PURE-TONE OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE LOGISTIC MODELS HEARING TESTS SUPPURATION

Objective: The goal of this work is the creation of word lists, in Ilocano, suitable for use in speech audiometry. Methods: First, estimates of the distribution of speech sounds and of the most common syllable structures in Ilocano were found from a phonetic transcription analysis of nearly 3000 words obtained from three magazine articles. Second, 372 two-syllable words were rated, for commonness, by fifteen native speakers of Ilocano who currently reside in Hawaii. Finally, various combinations of two-syllable words were made to produce 50-item lists. Results: First, an estimate of the distribution of speech sounds in Ilocano was found, with frequencies of occurrence ranging from 22.4 percent, for the speech sound /a/, to 0.007 percent, for the speech sound M. The syllable-structure analyses revealed that a very small number of distinct monosyllabic words were used very frequently. Two-syllable words were also used frequently, but were attributed to many distinct words. Second, from the rating results, approximately 70 percent of the two-syllable words in the rating survey were judged as common by 12 or more of the raters. Finally, four lists of 50 words each were constructed using only common two-syllable words with the most frequent two-syllable structures found in Ilocano. Each word list has a distribution of speech sounds that approximates that found from the phonetic analysis, and hence each list is roughly phonetically-balanced. Conclusions: These word lists may be of value to otolaryngologists and audiologists who work with native speakers of Ilocano. (Author)
AUDIOMETRY AUDIOMETRY ; SPEECH HEARING TESTS

Objectives: To identify the bacterial pathogens associated with chronic suppurative otitis media and their antimicrobial sensitivity and resistance. Study Design: Cross-sectional survey. Setting: The study was carried out from July 2004-July 2005 at the outpatient clinic of a government tertiary hospital. Number of subjects: A total of 32 patients (54 ears) with unilateral or bilateral active chronic suppurative otitis media. Results: Bacterial pathogens of 54 ear discharge samples from CSOM were studied. Among them, 42 (78 percent) were pure cultures and 9 (16.7 percent) were mixed, only 3 (5.6 percent) of the submitted samples had no growth. There were 42 pure isolates, the most common of which was Staphylococcus aureus 21 (50 percent), followed by Pseudomonas aeruginosa 14 (33.3 percent). Drug sensitivity pattern of Staphylococcus aureus showed that 61.9 percent were resistant to Penicillin while more than 90 percent were sensitive to Aminoglycosides and Clindamycin. Pseudomonas aeruginosa was resistant to penicillin in 64.3 percent of cases and Ciprofloxacin was active against pseudomonas in 85.7 percent. Conclusion: The most common bacterial pathogens from CSOM include Staphylococcus aureu and Pseudomonas aeruginosa. Majority of the isolates of Staphylococcus aureus were resistant to penicillin. Aminoglycosides, macrolides and quinolones were effective against most of the isolates of Staphylococcus aureus. (Author)
OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE TYMPANIC-MEMBRANE MASTOIDITIS CROSS-SECTIONAL STUDIES

Objectives: To determine the efficacy of a 7-day treatment of methylprednisolone 16mg in reducing the size of nasal polyps and on improvement of nasal symptoms. Methods: Design: Randomized double-blind placebo-controlled trial Setting: Out-patient department of the East Avenue Medical Center Patients: Patients 18 years old and above with nasal polyposis determined by history and endoscopic examination Results: There was a significant decrease in polyp size by an average of 16 percent (P < .05) among 12 out of the 23 patients (52.17 percent) in the steroid group versus placebo. The treatment group also exhibited an improvement in nasal symptoms of rhinorrhea, congestion and anosmia compared to the placebo. Conclusion: Medical treatment with oral methylprednisolone given at a low dose of 16 mg for one week resulted in reduction of the size of nasal polyps and improved the symptoms of rhinorrhea, nasal congestion and anosmia. Other associated symptoms like headache, epistaxis, sneezing, itchiness, epiphora, cough, postnasal drip, throat discomfort, facial pain, eyecomplaints and fever did not differ between the steroid and placebo groups. Recommendation: One week of oral steroids can be used to treat nasal polyps initially. If there is response, this mode of management can be combined with a long-term course of intranasal steroid sprays. Patients who do not respond may be referred for surgery. (Author)
NOSE DISEASES METHYLPREDNISOLONE OLFACTION DISORDERS POLYPS NASAL POLYPS

Objective:To design affordable, easy-to-use self-retaining retractors that can provide adequate exposure of the operative area in head and neck surgery Methods: Design: Surgical Instrumentation Setting: Tertiary government hospital Subjects: One Results: Self-retaining retractors were designed and fabricated from stainless steel with tissue prongs on one end and a loop for rubber-band attachment to surgical drapes via a towel clip on the other end. Varying prong lengths were devised for different depths of required retraction. Traction tension could be adjusted by varying rubber-band attachment distance. The retractors were tested on a patient undergoing open reduction and internal fixation for a mandibular fractureand evaluated according to ease of application, adequacy of exposure and tissue trauma. Conclusion: The self-retaining retractors may be affordable alternatives to commercially-available self-retaining retractors. They are easily applied with adjustable tension and depth of retraction that can provide adequate exposure with minimal tissue trauma.
INSTRUMENTATION