General Otolaryngology Clinic Research Articles

Clinical and financial audit of diagnostic protocols for lesions of the cerebellopontine angle.

To assess the diagnostic efficiency and costs of protocols used for investigating patients with suspected lesions of the cerebellopontine angle. Prospective evaluation of tests of auditory brain stem responses and acoustic reflex thresholds, electronystagmography, and calorics. Positive test results were confirmed or refuted by high resolution computed tomography with intravenous enhancement. Single general otolaryngology clinic in a teaching hospital. 270 consecutive patients with sensorineural hearing loss requiring investigation to exclude a lesion of the cerebellopontine angle. Estimated costs of various diagnostic protocols and performance in detecting tumours of the cerebellopontine angle. Protocols including tests of auditory brain stem responses and acoustic reflex thresholds as sifting tests before computed tomography were clinically acceptable and presented considerable savings over the use of computed tomography in all patients (74,000 pounds or 84,000 pounds v 122,000 pounds). The use of electronystagmography and calorics could not be justified on clinical or financial grounds. Audiological tests of auditory brain stem responses and acoustic reflex thresholds followed by computed tomography constitute the most cost effective protocol for determining suspected lesions of the cerebellopontine angle. The cost effectiveness of diagnostic protocols should be evaluated throughout the health service.

The globus symptom. Incidence, therapeutic response, and age and sex relationships.

The globus symptom was found to be the seventh most common initial complaint (4.1%) among 4,330 consecutive first-visit patients to a general otolaryngology clinic. Globus is a well-defined clinical symptom that is persistent, difficult to treat, and has a tendency to recur. The incidence is fairly constant among men. Relative to men, women are affected three times more commonly at 50 years of age and below and with equal frequency above 50 years. No seasonal variation in incidence was noted and men and women responded similarly to treatment. The incidence of gastroesophageal reflux symptoms in our patients with globus was 38% v 36% in the general population. Treatment response of the globus symptom was unrelated to treatment response of reflux symptoms even with antireflux therapy. We conclude there is no etiologic relationship between the globus symptom and gastroesophageal reflux.

Ear-cough (Arnold's) reflex.

A clinical survey of 688 patients revealed an incidence of Arnold's reflex in 1.74% of a general otolaryngology clinic population. There was no definite age, sex, or racial correlation found. The reflex was found unilaterally as well as bilaterally and in each canal quadrant, which is contrary to the previously described distribution of the nerve to the posterior and inferior parts of the canal. There was no predilection of a positive reflex with any particular ear disease.