Fork Tests Research Articles

Management of diabetic neuropathy with memantine: A randomized clinical trial.

Diabetes patients frequently experience diabetic neuropathy (DN), a microvascular complication that significantly reduces patients' quality of life. Memantine has demonstrated potential benefits for neuropathic pains in preclinical studies. This study aimed to assess the efficacy of memantine in the management of peripheral neuropathy in patients with type 2 diabetes mellitus (T2DM). This randomized clinical trial includes 143 diabetic patients (aged between 18 and 75years) with a confirmed diagnosis of diabetic neuropathy. Patients were randomly assigned to receive memantine 5mg twice daily for 1week, followed by 10mg twice daily plus gabapentin 300 mg daily (n = 72) or just gabapentin 300mg daily (n = 71) for 8weeks. The DN4 questionnaire, monofilament, tuning fork, and Tip-therm tests were used to measure neuropathy at baseline and after the 8-week intervention. The mean score of the DN4 questionnaire in the memantine group was significantly lower than the control group (p. value: .001). The number of patients with diabetic neuropathy remarkably decreased in the memantine group at the end of the study based on the performed tests (p. value: .001). Memantine functions as a beneficial agent in the management of diabetic neuropathy, which would significantly improve the quality of life in diabetic patients.

GRAFT UPTAKE AND HEARING AFTER ENDOSCOPIC PALISADE CARTILAGE MYRINGOPLASTY AT NEPAL MEDICAL COLLEGE TEACHING HOSPITAL

Background: Chronic otitis media mucosal type is commonly encountered in otorhinolaryngology. Myringoplasty is a common surgery performed to repair the tympanic membrane (TM). Management of subtotal perforation of the TM has become better with the use of endoscopes. The use of cartilage as palisade for repair of the TM has become popular. The aim of the study was to assess graft uptake and hearing after endoscopic palisade myringoplasty. Methods: A prospective study was conducted in the otorhinolaryngology department from April, 2022 to January, 2023. The study included 65 patients, aged 21 years and above diagnosed as chronic otitis media mucosal type, inactive with subtotal perforation and conductive hearing loss. History, clinical examination, otoscopy, tuning fork tests, examination under microscope (EUM) were conducted preoperatively. All patients underwent endoscopic palisade cartilage myringoplasty. Pre-operative and post-operative pure tone audiograms of the patients were done to record the air conduction threshold (ACT), bone conduction threshold (BCT) and air bone gap (ABG). SPSS 16 software was used for analysis of results. The statistical tests used for analysis was paired t-test, level of statistical significance was set at the P < 0.05. Results: The mean age of the patients was 28.51±7.20 years with a female preponderance (57.9%). Graft uptake following surgery was 91.9%. There was significant reduction (p<0.001) in the air bone gap postoperatively that suggested improvement in hearing. The mean hearing gain was 13.91±6.79 dB. Conclusions: The use of endoscopic palisade cartilage myringoplasty to correct subtotal perforation has good results in terms of graft uptake and hearing improvement.

Otolaryngology-Head and Neck Surgery Boot Camp in Preclinical Undergraduate Medical Education: A Pilot Study.

Objectives: There are limited opportunities in the medical school curriculum to learn about the field of Otolaryngology-Head and Neck Surgery (ORL) and to acquire relevant clinical skills, especially during preclinical years. The purpose of this pilot study was to investigate the impact of implementing an ORL boot camp in preclinical undergraduate medical education to help first- and second-year medical students learn about common ORL problems and become more comfortable performing basic ORL clinical skills so that they are better prepared to provide care for patients during clerkships and beyond. Methods: First- and second-year medical students were recruited to a single 3-hour boot camp session consisting of didactics/demonstrations and clinical experiences. The boot camp provided an introduction into the field of ORL, description of common ORL pathologies, associated management and procedures, and demonstrations of basic ORL procedures typically performed in clinic. Under supervision, subjects practiced complete head and neck physical examinations (H&NPE) on their peers including otoscopy, tuning fork tests, examination with a nasal speculum, and oral, basic cranial nerve, and neck examination. Pre- and post-tests assessing subjective (0-5 point Likert scale) and objective (content exam) measures of ORL knowledge, comfort level performing ORL skills, and interest in ORL were used to evaluate the intervention. Results: A total of 17 students participated in the boot camp as part of an extracurricular session. Seventeen students completed pre-tests and 16 completed post-tests. Ratings of self-reported knowledge of ORL (2.06 vs 3.00; P = .019) and comfort level in performing H&NPE (1.76 vs 3.44; P < .001) increased significantly after the boot camp. Mean performance on an ORL content exam also increased significantly from 42.17% to 71.35% (P < .001). Conclusions: An ORL boot camp may be an effective method of teaching for preclinical medical students. Further studies with a larger cohort are warranted.

Mineral bioaccessibility in 3D printed gels based on milk/starch/ĸ-carrageenan for dysphagic people

Dysphagia is a condition that affects the ability to chew and swallow food and beverages, having a major impact on people's health and wellbeing. This work developed gel systems with a customized texture suitable for intake by dysphagic people using 3D printing and milk. Gels were developed using skim powdered milk, cassava starch (native and modified by the Dry Heating Treatment (DHT)), and different concentrations of kappa-carrageenan (ĸC). The gels were evaluated in relation to the starch modification process and concentration of gelling agents, 3D printing performance, and suitability for dysphagic people (following both the standard fork test described by the International Dysphagia Diet Standardization Initiative (IDDSI), and also using a new device coupled to a texture analyzer). Moreover, the best formulations were evaluated for mineral bioaccessibility through simulated gastrointestinal digestion based on INFOGEST 2.0 standardized method. The results showed that ĸC had a dominant effect compared to the DHT-modified starch on gel texture, 3D printing performance, and fork tests. The gels obtained by molding or 3D printing resulted in different behaviors during the fork test, which was associated with the gel extrusion process that breaks down their initial structure. The strategies applied to tailor the texture of the milk did not affect the mineral bioaccessibility, which was kept high (>80%).

Effect of laser cutting of oak wood on the drying process

Abstract The subject of this paper is the analysis of the influence of laser cutting of oak wood on its drying process. The subject of the research was the comparison of the drying process and the quality of the dried wood in samples cut by classical technology (sawing) and samples cut with the use of laser. The research was carried out on two sets of samples which were subjected to an identical drying process. Continuous moisture loss and final moisture attained, moisture gradients before and after drying, and internal tensions before and after drying were monitored by means of the fork test and the cut-test. The final moisture content at the end of drying was 8.09% for the saw-cut samples and 8.22% for the laser-cut samples, a difference of only 0.13%. The analysis of the individual characteristics observed showed that the influence of the cutting technology did not have a significant effect on the drying process or the quality of the dried oak sawn timber.

A Comparative Study of Tympanoplasty with or without Mastoidectomy in Tubotympanic Type of Chronic Suppurative Otitis Media

Background: One of the most frequent ear illnesses in underdeveloped countries is chronic suppurative otitis media (CSOM). In the treatment of CSOM, otolaryngologists debate whether to perform tympanoplasty with or without cortical mastoidectomy. Objective: To compare the outcome of tympanoplasty with or without cortical mastoidectomy in the treatment of tubotympanic type chronic suppurative otitis media. Methods: This comparative study was carried out in the Department of Otolaryngology - Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2019 over a period of 02 years. A total number of 60 patients who underwent type 1 tympanoplasty with or without cortical mastoidectomy were enrolled in this study. After enrollment the condition of the pinna, preauricular region, postauricular region and external auditory cannal were examined. On otoscopy, site and size of perforation of tympanic membrane, condition of the rest of the tympanic membrane, condition of the middle car mucosa and the ossicles were also examined. Tuning fork tests, test for facial nerve integrity and fistula test were performed. Hearing level was assessed by pure tone audiometry with masking. Enrolled patients were grouped into two groups. Patients who underwent type- 1 tympanoplasty alone kept in group A and who underwent type 1 tympanoplasty with cortical mastoidectomy kept in group B. Complete blood count, blood urea, serum creatinine, random sugar, ECG and X-ray chest P/A view were done routinely. Results: Females were 76.7% in group-A and 53.3% in group-B. All patients were of age between 16 to 60 years and most of them were in the age group of 21-30 years. Majority of the patients were from rural area and maximum patients were from middle class family. In most of the patients unilateral ear involvement was observed. Perforation site was central malleolar in maximum cases followed by anterior central and posterior central. Perforation size was ........

Outcome of Tympanoplasty with Cortical Mastoidectomy in Tubotympanic Type of CSOM

Background: Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in under developing countries. Otolaryngologists debate whether to perform tympanoplasty with or without cortical mastoidectomy when treating CSOM. Objective: To see the outcome of tympanoplasty with cortical mastoidectomy for hearing gain and grafting success. Methods: This observational study was carried out in the Department of Otolaryngology - Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2018 to June 2020. A total of 30 patients who underwent type 1 tympanoplasty with cortical mastoidectomy were enrolled in this study. Following enrollment, the condition of the pinna, preauricular region, postauricular region, and external auditory canal were examined. The location and extent of the tympanic membrane perforation, the state of the remaining tympanic membrane, the health of the middle ear mucosa, and the ossicles were all examined during the otoscopy. Tuning fork tests, tests for facial nerve integrity, and fistula tests were also carried out. The hearing level was assessed by pure-tone audiometry with masking. Results: Among 30 patients’ females were 53.3% and males were 46.7%. All of the patients ranged in age from 16 to 60, with the majority of them falling between the ages of 21 and 30. Most of the patients came from middle-class families, and the majority of patients were from rural areas. The majority of patients showed unilateral ear involvement. Most often, the central malleolar region was perforated, then the anterior central region and the posterior central region. The most frequent perforation size was medium, followed by small, large, and subtotal. The pre- treatment bone conduction threshold was 11.74± 4.42 dB, which was reduced to 10.14 ±3.70 dB after treatment (p&lt;0.05). The pre-treatment air conduction threshold was 39.78± 8.76 dB, which was reduced to 26.45 ±9.19 dB after treatment (p&lt;0.05). The pre-treatment air-bone ..

Detection of sudomotor alterations evaluated by Sudoscan in patients with recently diagnosed type 2 diabetes

IntroductionDiabetic peripheral neuropathy (DPN) causes morbidity and affects the quality of life. Before diabetes diagnosis, neuropathic damage may be present. Sudoscan provides accurate measurement of the sudomotor function. This study...

Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture.

Background:Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal.Purpose:To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:A total of 50 patients with tibial pain (17 with bilateral symptoms) were assessed with 5 clinical examination tests (tibial fulcrum test, focal tenderness to palpation, heel percussion test, therapeutic ultrasound test, and 128-Hz tuning fork test) before they underwent diagnostic imaging (radionuclide bone scan). The application of the clinical tests was counterbalanced to minimize the likelihood of carryover effects. Patients provided a pain rating immediately before and after the application of each clinical test.Results:The prevalence of tibial SFx among the study participants was 52.2%. High levels of specificity were produced by the therapeutic ultrasound test (93.8%), tuning fork test (90.6%), and percussion test (90.6%). The fulcrum test had moderate to high specificity (84.4%). All tests demonstrated low levels of sensitivity, with the highest levels found for focal tenderness to palpation (48.6%) and fulcrum (45.7%). The fulcrum test provided the highest positive likelihood ratio (2.93), followed by the therapeutic ultrasound test (2.30). The fulcrum test had the lowest negative likelihood ratio (0.64), with the focal tenderness to palpation and tuning fork tests having negative likelihood ratios >1.0. Combinations of these clinical tests did not improve the prediction of tibial SFx above that observed among the individual tests.Conclusion:The clinical tests evaluated were generally highly specific, but all had low sensitivity. The fulcrum test provided the highest level of diagnostic accuracy; however, it was inadequate for definitive clinical management. Combining tests did not improve the diagnostic accuracy of tibial SFx.

1010 Audit of Acute Management of Sudden Onset Sensorineural Hearing Loss and Streamlining of Local Management Pathway

Abstract Aim Sudden onset sensorineural hearing loss (SSNHL) presents infrequently to ENT services in Aberdeen Royal Infirmary. Although ENT UK guidelines are in place for the management of SSNHL, the practicalities of organising these cases within our department can be challenging to junior staff leading to variation in time to review and timings of intervention. We Aimed to assessed current local practice in comparison compare it to national ENT UK guidelines Method Retrospective audit of 6 months data set recording management pathway of patients presenting with SSNHL to Rapid Access Clinic of Royal Aberdeen Infirmary Hospital. Electronic patient records were searched for: time of referral, duration of symptoms, times to first ENT review, intervention and audiogram, and timings and management during subsequent reviews. Results Seven patients meeting the inclusion criteria were identified and included in the audit. Average times from referral were calculated including time from referral to intervention (1.47 days), from referral to first ENT review (3.82 days), from referral to first audiogram (4.43 says). Average time from presentation to starting oral steroids was very efficient of just 0.33 days and average time from symptom onset to oral steroids initiation was 7.5 days suggesting late patient presentation. Conclusions The data gather helped our department to reinforce management pathway of SSNHL as per ENT UK guidelines and improved the way urgent audiograms are organised in the hospital. It also emphasised the importance of performing tuning fork test to determine the nature of hearing loss when audiogram is not immediately available.

154 ‘You’ve Lost Your Tuning Form’ – Don't Worry I Have the Solution…

Abstract Background Patients are frequently referred to ENT emergency services with sudden hearing loss. Differentiating sensorineural from conductive losses is paramount in establishing the urgency of review and when to commence urgent steroid therapy. Tuning fork tests are useful for this, but they are not always readily available in primary care or the emergency room. Aim To identify and evaluate an alternative method to Weber's test for differentiating conductive from sensorineural hearing loss. Method A pilot prospective diagnostic accuracy study was designed to include 10 individuals with unilateral conductive and 10 with asymmetrical sensorineural hearing loss. Each individual was subjected to a pure tone audiogram (PTA), Weber's test and the new index test. Results The new index test showed 100% correlation (r=1) with Weber's test and 90% sensitivity, specificity and overall accuracy when compared to Weber's test for diagnosing conductive and sensorineural hearing loss. Conclusion This new test may be used as an alternative to Weber's test when a tuning fork is not available. It might even replace the need for Weber's test when PTA testing is readily available. This test could be used to triage referrals and differentiate conductive from sensorineural hearing loss. Conflicts There are no conflicts to declare.

Lateralization Pattern of the Weber Tuning Fork Test in Longstanding Unilateral Profound Hearing Loss: Implications for Cochlear Implantation.

The Weber tuning fork test is a standard otologic examination tool in patients with unilateral hearing loss. Sound should typically lateralize to the contralateral side in unilateral sensorineural hearing loss. The observation that the Weber test does not lateralize in some patients with longstanding unilateral deafness has been previously described but remains poorly understood. In the present study, we conducted a retrospective analysis of the medical records of patients with unilateral profound hearing loss (single-sided deafness or asymmetric hearing loss) for at least ten years. In this patient cohort, childhood-onset unilateral profound hearing loss was significantly associated with the lack of lateralization of the Weber tuning fork test (Fisher’s exact test, p < 0.05) and the absence of tinnitus in the affected ear (Fisher’s exact test, p < 0.001). The findings may imply a central adaptation process due to chronic unilateral auditory deprivation starting before the critical period of auditory maturation. This notion may partially explain the poor outcome of adult cochlear implantation in longstanding single-sided deafness. The findings may suggest a role for the Weber test as a simple, quick, and economical tool for screening poor cochlear implant candidates, thus potentially supporting the decision-making and counseling of patients with longstanding single-sided deafness.

Politzer's test - but which one? A plea for standardisation of terms in otology.

Politzer's tuning fork test is a little-known special examination with a chequered history. This paper gives Politzer's original description, and explains how he intended it to be used. The historiographical research in this study is based on primary references. Secondary documentation is only cited when it is necessary to substantiate any historical argument. After the apparent disappearance of Politzer's tuning fork test from the otological scene in the 1950s, its consequent resurrection was not what it seemed. This story underlines the need for a standardisation of otological nomenclature, particularly when eponyms are used.

Luc’s Abscess: The Zygomatic Route of Infection from Cholesteatoma

Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions. CASE REPORT A 23-year-old man had a three-month history of yellowish, mucoid, foul-smelling left ear discharge associated with multiple episodes of non-projectile watery vomiting (&lt; 1 cup each) and left-sided facial paresis. These symptoms were accompanied by ipsilateral hearing loss, tinnitus and dizziness prompting consult and admission to a secondary hospital. A cranial Computed Tomographic (CT) scan showed a cholesteatoma in the left ear. The facial asymmetry improved, vomiting was resolved with intravenous antibiotics, hydration, and an anti-emetic, and he was subsequently discharged. He continued to have recurrent, foul-smelling left ear discharge and left hemifacial paresis persisted. Left-sided otorrhagia and ipsilateral hemifacial paresis were subsequently associated with left hemifacial swelling, otalgia (VAS of 7/10, described as sharp), and decreased hearing, prompting an outpatient consult with a private ENT specialist. The symptoms persisted despite 7 days of oral ciprofloxacin, this time associated with drowsiness, neck pain and febrile episodes. The patient consulted in our institution and was advised emergency admission. He was admitted drowsy, coherent with GCS 15 (E4V5M6). The left temporal area was edematous and tender, extending to the ipsilateral post-auricular area inferiorly and frontal area superiorly. (Figure 1) Otoscopy revealed yellowish, foul-smelling, copious muco-purulent discharge and near-total perforated left tympanic membrane. The right ear had unremarkable otoscopic findings. Tuning fork tests at 512 Hz were consistent with sensorineural hearing loss in the left ear with House-Brackmann IV facial nerve paresis. Brudzinski and Kernig tests were negative with no signs of dysmetria, dysdiadochokinesia or dysarthria on cerebellar testing. Gram stain and KOH smears of the left ear discharge revealed C fruendii and fungal elements. High resolution temporal bone CT scan showed otomastoid disease on the left with automastoidectomy defect, associated subperiosteal and intracerebral abscess formation on the left, with otherwise unremarkable right temporal bone. (Figure 2)

Study of Incidence and Prevalence of Diabetic Peripheral Neuropathy in Type II Diabetes Mellitus by Bedside Screening Techniques at a Tertiary Care Centre

Introduction: Diabetes mellitus commonly leads to peripheral neuropathy in patients with chronically high blood sugar levels. Diabetic peripheral neuropathy leads to numbness, loss of sensation or may have extremely painful symptoms. In some patients there might be marked neuropathic deficit which may be unnoticed. Objectives: Hence to evaluate patients with diabetes mellitus helps in early screening of peripheral neuropathy. Methodology: This involves using the bedside screening techniques like monofilament test, biothesiometer, tuning fork test and diabetic symptom and examination questioner. Results: Diabetic neuropathy was most commonly present in poor control of diabetes (67%) followed by fair control (24%) and good control (9%). It was observed that severity of peripheral neuropathy was related with blood sugar. With high frequency of patients leading to diabetic peripheral neuropathy the observation is that morbidity remains high in such patients. Conclusion: Diabetic peripheral neuropathy is a major complication of diabetes mellitus. Rapid diagnosis and management are important, since recent modalities include like tricyclic antidepressants or anticonvulsants and optimal glycemic control can improve outcome of these patients. Early diagnosis of diabetic peripheral neuropathy is considered at risk of foot ulcerations and must receive preventive education and care.

Traumatic Perforation of Tympanic Membrane

Introduction: Traumatic perforation of tympanic membrane (TM) is caused by increase in air pressure due to slapping, road traffic accident, blast injury, syringing, trauma by ear buds, etc., The incidence has been increased in recent times due to increased domestic violence and road traffic accidents. Hence, there is a need for early identification, evaluation, and management to reduce the morbidity. Objectives: The objective of the study was to describe etiologies of traumatic perforation of TM, to assess the findings of pure tone audiometry (PTA) among patients with traumatic perforation of TM, and to determine the outcome. Materials and Methods: This study was done between November 2017 and May 2019 in the department of ENT at Bangalore Medical College and Research Institute on 88 patients with traumatic perforation of TM who were subjected to otoscopic examination, tuning fork tests, and PTA. Patients were followed up on weekly basis. Results: Out of 88 patients, 33 patients (37.5%) were in the age group of 21–30 years. Fifty-four were males (61.36%) and 34 were females (38.63%). Slapping is the most common mode of injury with 50 (56.8%) patients. Left ear 55 (62.5%) was more commonly involved than right ear 33 (37.5%). Small perforation 55 (62.5%) was more common followed by medium-sized perforation 25 (28.4%) and large perforations were the least 8 (9.1%). Multiple quadrants were involved in 33 patients (37.5%). Posteroinferior quadrant was most commonly involved. Deafness (75%) was the most common symptom involving 66 patients. Average time taken for spontaneous healing was 37 days. Mean hearing improvement compared between hearing loss at the time of trauma and after 3 months was 13.18 ± 7.05 dB, which is statistically significant (P = 0.0001). Conclusion: Traumatic perforation of TM spontaneously healed in 80 participants (90.90%), whereas eight participants (9.09%) underwent surgery, i.e., tympanoplasty.

IDF21-0007 Is adherence to an exercise program an important key to reduce foot ulcer risk?

Background: Diabetic foot is one of the most prevalent complications of diabetes. It has the potential risk of pathologic consequences including infection, ulceration and amputation, and is associated with disability, death and substantial costs. Diabetic foot result from neuropathy and/or ischemia and the premature identification of risk factors may avoid ulcerations and amputations. Several benefits in this area can be induced by different exercise programs, although effects of physical activity have a dose–response pattern. Aim: This study aimed to investigate the association between foot ulceration risk and adherence to a multi-component exercise program in middle-aged and older patients with type 2 diabetes (T2D). Method: The study involved 79 individuals with T2D recruited from primary health care units to participate in Diabetes em Movimento® Vila Real (Portugal). This community-based exercise program is composed by three exercise sessions per week, 75 min per session (aerobic, resistance, agility/balance, and stretching exercise), during nine months. Risk of ulceration was assessed before and after the exercise program, with a protocol that included patients’ relevant clinical history, clinical foot examination (observation of structural and dermatological characteristics, 10-g Semmes-Weinstein monofilament test, 128-Hz tuning fork test, and palpation of peripheral arterial pulses), and the evaluation of the difficulties in taking care of the feet (ability to see both the plantar surfaces). One-way ANOVA was used to analyze the association between exercise program adherence and changes in the risk of ulceration (improved, unchanged, worsened). Results: 75 individuals concluded the study and were included in final analysis (35 men, 40 women 64.43 ± 7.05 years old, body mass index 29.98 ± 4.41 kg/m2, non-smokers). After nine months of exercise (overall exercise intensity of 12.73 ± 0.95 points in Borg rating of perceived exertion scale of 6–20 points), 26 subjects (34.7%) decreased risk of ulceration, 35 (46.7%) maintained the risk, and 14 (18.6%) increased the risk. Those who decreased the risk had higher adherence to exercise program than those who increased the risk (65.60% versus 45.43%, p < 0.05, partial η2 = 0.14). Overall, participants’ adherence to exercise was 58.85 ± 25.18 % (ranging from 3.70 to 98.15%). Discussion: The results of this study suggest that higher compliance to an exercise program seems associated with a decrease in the risk of foot ulceration in middle-aged and older patients with T2D. Besides the need for implementation exercise programs for T2D control and related comorbidities, there is an urgent demand to develop motivation strategies to increase exercise adherence in order to maximize physical activity benefits. Funding: This work was supported by the Foundation for Science and Technology (FCT, Portugal) and European Social Fund (ESF), through a Doctoral grant endorsed to the first author (SFRH/BD/143195/2019) under the Norte 2020 – Norte’s Regional Operation Programme.

A Study to Assess the Effect of Size & Site of Tympanic Membrane Perforation on Hearing Loss.

The objective of the study was to assess the effect of size & site of tympanic membrane perforation on hearing loss. The study was carried out in ENT department of a tertiary health care hospital, between October 2018 and March 2020 (a total of 18months). Patients aged 15-50years having chronic otitis media with dry central perforation were included in the study after taking informed written consent and were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for Tympanoplasty and just prior to the procedure, the tympanic membrane perforation size was measured using the Castroviejo caliper and site was noted using otomicroscopy. The status of the middle ear mucosa and ossicles were also analyzed to ensure normal middle ear mucosa and normal ossicular mobility and continuity and only then were these patients included in the study. All the patients in the study were evaluated for hearing loss using air conduction measurements in pure tone audiometry done at 250Hz, 500Hz, 1000Hz, 2000Hz, 3000Hz and 4000Hz. Hearing loss was found to be directly proportional to the size of perforation in our study. The site of the perforation has a significant association with the degree of hearing loss. Those perforations with posterior quadrant involvement and multiple quadrant involvement had a higher hearing loss. From our study, we concluded that there is a significant relationship between size and site of the perforation and the amount of hearing loss.

Combined Utility of the Semmes-Weinstein Monofilament and the Timed Vibration Test in the Prediction of Diabetic Foot Ulcers.

Neurologic screening tests are often used to identify and stratify patients at risk for diabetic foot complications such as infections, ulcers, and amputations. Two of the most commonly cited methods are the 5.07 Semmes-Weinstein monofilament (SWM) for loss of protective sensation and vibratory sensation testing. The aim of this study was to determine whether combined SWM and the timed vibration test (TVT) more effectively predicts diabetic foot ulcer (DFU) development compared with each test alone. An electronic medical record database search was performed restricted to podiatric medical clinic patients with diabetes and DFU ICD-10 diagnosis codes. Of 200 patients who met the criteria, 24 developed DFUs. A statistical analysis was performed comparing the SWM and TVT at various cutoff times and the combined SWM/TVT in their ability to predict DFUs. Statistical analysis revealed that the TVT cutoff time of less than 4 sec was superior to the other times for prediction of DFUs. The combined SWM/TVT results at less than 4 sec were superior to each test individually: sensitivity, 87.5%; specificity, 84.7%; positive predictive value, 43.8%; and receiver operating characteristics area under the curve, 0.86. The SWM combined with TVT was shown to be superior compared with either test alone in discriminating DFU risk. In addition, the TVT cutoff time of less than 4 sec proved to have greater diagnostic yield than other times, including 0 sec. This unexpected finding might impact providers relying on the absence of vibration sensation via tuning fork testing as an optimal marker of DFU risk.

Tinnitus Evaluation in Type 1 Diabetes Mellitus at Tertiary Hospital Malaysia.

To determine the prevalence of tinnitus in Type 1 Diabetes Mellitus (T1DM) patients, to evaluate its severity and to correlate it with estimated Glomerular Filtration Rate (eGFR) as well as glycaemia control (HbA1c). We performed a questionnaire-based cross-sectional study at Hospital Canselor Tuanku Muhriz (HCTM) from a period of 15 months. A total of 133 T1DM patients who fulfilled our study's criteria were subjected to otoscopy examination, tuning fork test and free field voice test. The mini-Tinnitus Questionnaire (TQ) was used to assess the severity of tinnitus. We were careful to categorize the perceived duration of tinnitus. The prevalence of tinnitus among T1DM patients was 24.1% (32/133 patients). Out of 32 patients, approximately 78.1% (25 patients) had a compensated level of tinnitus distress and the remaining 21.9% (7/32) had moderate tinnitus. The duration of tinnitus ranged from 2 seconds to 2 minutes, whıch was ringing and intermittent in nature. The HbA1c and estimated Glomerular Filtration Rate (eGFR) were higher in tinnitus compared to the non-tinnitus group. There was no significant correlation between the severity of tinnitus and HbA1c level or eGFR. Our study concluded that tinnitus amongst T1DM patients was likely to be non-pathological in view of its short duration with minimal to no distress to the sufferers. An elevated HbA1c may increase the risk of developıng tinnitus.