Tuning Fork Tests Research Articles

Changes in the hearing threshold using high frequency audiometry in medical personnel exposed to ionizing radiation

<p class="abstract"><strong>Background:</strong> Effect on sensorineural hearing loss by low dose ionizing radiation exposure in radiation workers has been rarely evaluated. A case control study was done among the radiation associated workers and normal subjects.</p><p class="abstract"><strong>Methods:</strong> The study was designed in low dose of radiation exposing healthy medical personnel. Age and sex matched healthy control group of subjects were selected. Groups were evaluated by normal otoscopic evaluation; normal tuning fork test and normal standard pure tone audiogram at frequencies from 250 to 8000 Hz. They underwent impedance audiometry, transient evoked otoacoustic emissions, and high frequency audiometry (from frequencies 10000 to 20000 Hz) was done. </p><p class="abstract"><strong>Results:</strong> No statistically significant difference was found in the results of impedance audiometry, transient evoked otoacoustic emissions and standard pure tone audiogram from 250 to 8000 Hz between cases and controls. In the high frequency range, statistically significant difference was observed (p=0.0001). Mean thresholds were higher at all frequencies in cases compared to controls, except at 4000 Hz. A statistically significant correlation was found between duration of exposure and thresholds at 500 Hz (p=0.014) and 10000 Hz (p=0.048). Tinnitus, vertigo, ear block, hard of hearing and loss of appetite were seen more in cases, but was not significant.</p><p class="abstract"><strong>Conclusions:</strong> Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.</p>

Novel stress corrosion testing method for high‐strength steels

This paper presents a novel TFT (tuning fork test) stress corrosion testing method, which was developed for classifying martensitic high‐strength steels. The novel method was developed by applying finite element calculations to optimize a tuning fork geometry to enable accurate stress adjustment with simple inexpensive equipment. Different steels were exposed to cathodic hydrogen charging conditions with various elastic tensile stress levels that were achieved by displacement control. All steels exhibited hydrogen‐induced stress corrosion cracking after exceeding a material‐specific threshold stress level that decreased linearly with increasing hardness.

Prevalence of ear disease and associated hearing loss among primary school students in the Solomon Islands: Otitis media still a major public health issue

ObjectiveThe present study aimed to assess the prevalence of otitis media and associated hearing loss among primary school students in the Solomon Islands. MethodsA total of 604 primary school students (280 males, 324 females) aged 4–15 years were assessed in two primary schools (government, nongovernment) in the capital city Honiara. School-based ear examinations were performed, including otoscopy and tuning-fork tests. Students were referred to the ENT Clinic for medical intervention and/or pure-tone audiometry assessment. ResultsA total of 342 students (56.6%) did not pass their ear examination, with a significantly higher fail rate among younger students (p < 0.001). The most common ear pathology was Otitis Media with Effusion (OME) (34.2%), followed by impacted wax (22.8%), and Chronic Suppurative Otitis Media (3.1%). The follow-up attendance rate at the ENT Clinic was 81.1%. Among students with OME in at least one ear, 50% failed audiometry screening in the affected ear. While age was a significant factor for OME, it was not a significant factor for OME-associated hearing loss. ConclusionsEar diseases with associated hearing loss are a significant public health problem among primary school students in the Solomon Islands. The implementation of routine School Ear and Hearing Programs could be beneficial, and should reduce the national burden of ear diseases.

Lower limb ischemia and microrheological alterations in patients with diabetic retinopathy.

Diabetes mellitus is frequently associated with vascular pathologies and hemorheological disorders. 105 patients with diabetic retinopathy (DRP) (mean age 64.64±9.01 years, 56 males, 49 females), 35 age-matched non-diabetic (mean age 61.65±7.6 years, 14 males and 21 females) and 42 young healthy volunteers (mean age 25.52±3.32 years, 22 males, 20 females) were recruited. Lower extremity artery disease (LEAD) and microcirculatory alterations were screened by hand-held Doppler, transcutaneous partial tissue oxygen tension (tcpO2), tuning fork test, 6-minute walk test, erythrocyte aggregation and deformability. High prevalence of LEAD was detected in diabetic population: 55.3% fulfilled the criteria of LEAD based on ankle-brachial index; severely impaired tcpO2 was measured in 18.6%. The results of non-invasive measurements of the diabetic patients were significantly worse than those of the control groups (p < 0.05). Hemorheological disturbances could be characterized by the significantly higher erythrocyte aggregation (p < 0.05) and lower erythrocyte deformability (p < 0.05) in the diabetic population. Macro- and microcirculatory lower limb disorders could be revealed at high prevalence in diabetic patients with retinopathy. Measurement of tcpO2 and hemorheological variables could be useful to discover patients at higher risk for diabetic foot complications.

Diagnostic Accuracy of Tuning Fork Tests for Hearing Loss: A Systematic Review.

Objective (1) To determine the diagnostic accuracy of tuning fork tests (TFTs; Weber and Rinne) for assessment of hearing loss as compared with standard audiometry. (2) To identify the audiometric threshold at which TFTs transition from normal to abnormal, thus indicating the presence of hearing loss. Data Sources PubMed, Ovid Medline, EMBASE, Web of Science, Cochrane, and Scopus and manual bibliographic searches. Review Methods A systematic review of studies reporting TFT accuracy was performed according to a standardized protocol. Two independent evaluators corroborated the extracted data and assessed risk of bias. Results Seventeen studies with 3158 participants, including adults and children, met inclusion criteria. The sensitivity and specificity of the Rinne test for detecting conductive hearing loss ranged from 43% to 91% and 50% to 100%, respectively, for a 256-Hz fork and from 16% to 87% and 55% to 100% for a 512-Hz fork. The audiometric thresholds at which tests transition from normal to abnormal ranged from 13 to 40 dB of conductive hearing loss for the Rinne test and from 2.5 to 4 dB of asymmetry for the Weber test. Significant heterogeneity in TFT methods and audiometric thresholds to define hearing loss precluded meta-analysis. There is high risk of bias in patient selection for a majority of the studies. Conclusion Variability exists in the reported test accuracy measurements of TFTs for clinical screening, surgical candidacy assessments, and estimation of hearing loss severity. Clinicians should remain mindful of these differences and optimize these techniques in specific clinical applications to improve TFT accuracy.

Hearing Status of the Traffic Police with or without Use of Sound Protector in Dhaka Metropolitan City

Background: Sound protector is an essential tool to protect hearing.Objective: The purpose of the present study was to see the hearing status of traffic police with or without sound protector.Methodology: The cross-sectional study was conducted in the Department of Otolaryngology and Head Neck Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2003 to June 2004 for a period of one and half year. Traffic police who were working in the Dhaka metropolitan city at any age were included as study population. Hearing status was measured to all subjects. The traffic police at any age working in the Dhaka metropolitan city with the duration of service more than 5 years were included as study population. Otoscopic examination, tuning fork test and pure tone audiometry were performed by clinical audiometer (AC 33) with two channels, with TDH39 earphones among the entire study subject.Result: A total number of 100 traffic polices working in Dhaka metropolitan city were examined. Highest (56%) number of the respondents was in between 30 to 40 years of age group. The mean age with SD was 36.15 ±5.5. In this study 53.0% respondents found to have exposure of 6 to 10 years and 16.0% found to have exposure between 16 to 20 years. It was found that 26 traffic police used ear protector occasionally. Among them 7(26.9%) subjects had different degree of hearing loss. Nonusers had higher rate (23%) of hearing loss (p=0.685).Conclusion: In conclusion use of sound protector by traffic police is not significantly related with the hearing loss though this is clinically significant.Journal of Current and Advance Medical Research 2017;4(1):13-16

Retrospective analyses of high-energy explosive devicerelated injuries of the ear and auricular region: experiences in an operative field hospital emergency room.

With the changing conditions of terrorism, particularly in urban areas, high-energy explosive devices such as improvised explosive devices (IEDs) and projectile missiles (PMs) are frequently used. Traumas caused by these devices particularly affect the maxillofacial region and typically lead to otologic problems. In this study, we aimed to evaluate otologic complaints, otoscopic and auricular examinations, and tuning-fork tests of patients who were exposed to high-energy blast-related injuries and perform a comparison between trauma patients injured by IEDs and PMs. The medical data of patients admitted to an operational field hospital emergency room with injuries related to highenergy explosive devices such as IEDs and PMs between July 27, 2015 and July 22, 2016 was reviewed. The hearing impairment, tinnitus, otologic examination, auricular region examination, and tuning-fork tests of all patients were evaluated. The otologic evaluation, records of the patients (n=86) were evaluated using a scoring system established by the authors. The patients were categorized into two groups according to the device causing the injury: IEDs in group I and PMs in group II. A total of 241 combatants were injured by high-energy explosive devices. All patients were male with a mean age of 30.2 years (range, 20-54). Of these, 86 had hearing impairments that were detected by tuning-fork tests. Of those, 50 were injured by IEDs and 36 by PMs. Of the 86 patients, 18 had traumatic tympanic membrane perforation, and of those, 6 patients were injured by IEDs and 12 by PMs. Further, 68 of the 86 patients had sensorineural hearing loss, and of those, 44 were injured by IEDs and 24 by PMs. There was a statistically significant difference between the IED and PM groups according to otologic evaluation score (p=0.044). This study demonstrates that PMs can have a large impact on the human ear and may cause more severe otologic manifestations among combatants than those caused by IEDs. The early and accurate evaluation of patients exposed to high-energy explosive devices in an operational field is important for the appropriate management of these patients.

UJI DIAGNOSTIK SKORING TORONTO DAN MODIFIKASI TORONTO, TES MONOFILAMEN, SENSASI GETAR DENGAN GARPUTALA 128 HZ PADA POLINEUROPATI DIABETIKUM

Background. The prevalence of diabetes mellitus has been epidemically increasing throughout all the world population, and diabetic polyneuropathy (PNP-DM) is one of the most common neurologic manifestation of this disease. Clinical research has proved that effective bedside screening of PNP-DM can significantly reduce the incidence of foot ulcer and limb amputation. Objective. To measure the diagnostic test of polyneuropathy scoring, monofilament 10-g SemmesWeinstein test, and 128 Hz tuning fork test as an early detection measure for PNP-DM. Methods. This research was conducted using a cross sectional approach from Januari 2016 to Juli 2017. Results. Among the total study population of 43 (23 men and 20 woman), Modified Toronto Score has the highest sensitivity (100%), PPV (93%) and accuracy (93%). Toronto score has the highest NPV (9%). Conclusion. Modified Toronto Score has good diagnostic value as screening tool in PNP-DM.

Comparison of Four Screening Methods for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients: A Cross Sectional Study

The diabetes situation in Malaysia is about 3.5 million or 17.5 per cent of its citizens aged 18 years and above are Diabetic. Diabetic peripheral neuropathy (DPN) is common and frequent cause of morbidity and disability. Early diagnosis and appropriate treatment are important to prevent disease complications, especially diabetic foot and ulceration. The aim of this research was to find out the prevalence of DPN, to determine which of the 4 screening methods (Michigan Neuropathy Screening Instrument (MNSI), Ankle Reflexes, 128-Hz Tuning Fork Test and 10-g Monofilament) was more reliable in screening for DPN and any correlation between them. A cross-sectional study with a random sample size of (N=81), type 2 diabetes mellitus participants in Diabetes Malaysia headquarters were screened for presence of DPN by using 4 different methods. Reliability and correlation between the 4 screening methods were calculated. The prevalence of DPN was 46.91% using MNSI. Prevalence of DPN using 10-g Monofilament test was highest (45.68%) and ankle reflexes were lowest (17.28%). Statistical significant associations were found between 10-g monofilament, MNSI Score, right and left ankle reflex, 128-Hz Tuning Fork Test on the right and left great toe. There was positive correlation between 4 screening methods and were reliable to be used to screen for DPN in type 2 diabetes mellitus patients. However MNSI and 10-g Monofilament test were more appropriate and reliable in screening for DPN.

Flexible and wearable 3D graphene sensor with 141 KHz frequency signal response capability

We developed a flexible force sensor consisting of 3D graphene foam (GF) encapsulated in flexible polydimethylsiloxane (PDMS). Because the 3D GF/PDMS sensor is based on the transformation of an electronic band structure aroused by static mechanical strain or KHz vibration, it can detect frequency signals by both tuning fork tests and piezoelectric ceramic transducer tests, which showed a clear linear response from audio frequencies, including frequencies up to 141 KHz in the ultrasound range. Because of their excellent response with a wide bandwidth, the 3D GF/PDMS sensors are attractive for interactive wearable devices or artificial prosthetics capable of perceiving seismic waves, ultrasonic waves, shock waves, and transient pressures.

Diagnostic Accuracy of Clinical Decision Rules to Exclude Fractures in Acute Ankle Injuries: Systematic Review and Meta-analysis

BackgroundAnkle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule. ObjectivesThe purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma. MethodsA systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies. ResultsEighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively. ConclusionThe OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.

VALIDITAS PEMERIKSAAN GARPU TALA 128 HZ SEBAGAI DETEKSI DIABETIC PERIPHERAL NEUROPATHY PADA PASIEN DIABETES MELITUS TIPE 2 DI RSUD DR. H. MOCH ANSARI SALEH BANJARMASIN

Abstract: Diabetic peripheral neuropathy (DPN) is one of major complication on uncontrolled diabetes mellitus (DM) patient. Test of 128 Hz tuning fork is a simple test to detect DPN which is recommended by several international guidelines and available at a limited health facility. This research aimed to discover the validity of 128 Hz tuning fork test as diabetic peripheral neuropathy detection on type 2 diabetes mellitus patient at Dr. H. Moch. Ansari Saleh Banjarmasin hospital. This was diagnostic test research with a cross-sectional design. Data was analyzed by using diagnostic test of 2x2 table and receiving operating characteristic (ROC) curve. Subjects were 69 DM outpatient at internal medicine clinic in Dr. H. Moch. Ansari Saleh Banjarmasin hospital. The analysis results were sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve. Respectively they were 40%; 100%; 100%; 73,33%; 78,26%; and 70% (0.7) (CI 95%: 55.9%-84.1%). The test of 128 Hz tuning fork has fine validity and can be used as DPN detection on type 2 DM patient. Keywords: Validity, tuning fork 128 Hz test, diabetic peripheral neuropathy, diabetes mellitus Abstrak: Diabetic peripheral neuropathy (DPN) merupakan salah satu komplikasi tersering pada pasien diabetes melitus (DM) yang tidak terkontrol. Pemeriksaan garpu tala 128 Hz adalah salah satu pemeriksaan sederhana untuk mendeteksi DPN yang direkomendasikan oleh beberapa guideline internasional dan dapat dilakukan di fasilitas kesehatan dengan fasilitas terbatas. Penelitian ini bertujuan untuk mengetahui validitas pemeriksaan garpu tala 128 Hz sebagai prosedur deteksi neuropati perifer pada pasien diabetes melitus tipe 2 di RSUD Dr. H. Moch. Ansari Saleh Banjarmasin. Penelitian ini merupakan uji diagnostik dengan pendekatan cross-sectional. Data dianalis dengan uji diagnostik tabel 2x2 dan kurva receiving operating characteristic (ROC). Subjek penelitian merupakan 69 pasien DM rawat jalan poliklinik penyakit dalam RSUD Dr. H. Moch. Ansari Saleh Banjarmasin. Hasil analisis yang didapatkan adalah sensitivitas, spesifisitas, nilai prediktif positif, nilai prediktif negatif, akurasi, dan area under curve dari pemeriksaan garpu tala 128 Hz berturut-turut adalah 40%; 100%; 100%; 74,57%; 78,26%; dan 70% (0.7) (IK 95%: 55.9%-84.1%). Pemeriksaan garpu tala 128 Hz mempunyai validitas yang cukup baik dan dapat digunakan sebagai deteksi DPN pada pasien DM tipe 2. Kata-kata kunci: Validitas, pemeriksaan garpu tala 128 Hz, diabetic peripheral neuropathy, diabetes melitus

Aetiological factor for chronic suppurative otitis media: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Otitis media (OM) refers to a group of complex infectious and inflammatory diseases affecting the middle ear. The present study was conducted to understand the various aetiological factors in chronic suppurative otitis media (CSOM) and also to take into possible hereditary factors&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study was conducted in 150 patients who had visited or were admitted at department of otorhinolaryngology and Head and Neck Surgery, Shree Sayaji General (SSG) Hospital, Vadodara, Gujarat. Detailed history regarding the illness was taken then clinical examination was carried out on the patient in a systemic manner, otoscopic examination, tuning fork test and pure tone audiometry was done. All the findings are noted in proforma. Means of both groups were compared by independent student t-test&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Most of the patients were in lower socioeconomic class (59.33) and lower middle class (40.67). Fifty out of the 150 chronic suppuurative Otitis Media patients, had a history of discharge for more than 10 years of duration. DNS and septal spur was found as positive finding in 49 patients of CSOM. X-ray of mastoid Schuller’s view was done in 87 patients, out of which 62 patients X-ray showed sclerosis of mastoid air cells, 16 cases showed partly pneumatization of mastoid air cells&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Chronic otitis media is an important cause of morbidity in very large group of Indian population. Between 20-40 years of age septal pathology was main aetiological factor for CSOM&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

A study of clinical and audiometric profile in patients presenting with sudden sensorineural hearing loss

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To assess the clinical and audiometric profile in patients presenting with sudden sensorineural hearing loss (SSNHL).The study also aimed to find out any possible etiology of SSNHL, prognostic factors and effectiveness of treatment. Prospective, open label, randomized study conducted in department of ENT at the Ram Lal eye and ENT hospital attached to Government medical college, Amritsar, Punjab, India.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 50 patients of either sex aged between 18 to 50 years suffering from unilateral or bilateral onset SSNHL included in the study on the basis of predetermined clinical criteria. The hearing assessments of patients were done before and after the treatment with tuning fork tests, pure-tone and impedance audiometry. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Most of the patients of SSNHL presented with unknown etiology. Steroid treatment gave a statistically significant improvement in pure tone averages. Maximum improvement is observed in patients who started treatment within one month of developing SSNHL. Post-treatment outcomes were not influenced by age of the patient and type of the pure tone audiometry graph. The presence of vertigo and diabetes are bad prognostic factors for hearing outcome in SSNHL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most of the cases of sudden sensorineural hearing loss have unknown etiology. Patients with associated DM and vertigo are having poor recovery of hearing. Early starting of treatment gives maximum improvement of hearing. &lt;/p&gt;

A rare complication of tuning fork test

Incidence of tuning fork-related complication is extremely rare. Here, we report a case of an 18-year-old gentleman who presented with a recurrent left ear discharge with a central perforation for the past 7-year duration. Left myringoplasty was performed after the ear condition was permissible. One week after surgery, he presented with an erythematous lesion over his forehead secondary to a tuning fork test which was done prior discharge.

Tympanometric assessment of Eustachian tube function as a prognostic indicator in myringoplasty

Aim To determine eustachian tube function in tubo-tympanic type of chronic ear disease and correlate it with pathological changes in middle ear. Objective To ascertain whether eustachian tube function had any demeanor upon the outcome of myringoplasty. Backgound The prevailing interest in the patho-physiology of the eustachian tube has been stimulated by the persistent incidence of middle ear effusion and chronic otitis media. The ongoing sophistication in current middle ear reconstructive surgery has added more dimensions to the study of eustachian tube and its effects in the course of reconstructive middle ear surgery. One of the prime elements accountable for failure of reconstructive middle ear surgery has been tubal dysfunction. Method In the present study eustachian tube function was evaluated in in 30 patients who were undergoing myringoplasty for tubo-tympanic type of chronic suppurative otitis media having central perforation by tuning fork tests, microscopic evaluation of the middle ear mucosa and Impedance audiometry. Results 70% of the myringoplasty cases had good surgical outcome and of the 24 cases that had good eustation tube function 87.5% had successful surgical outcome remaining cases had recurrence of otorrhea. Conclusion The results were validating good eustachain tube function as a criterion for electing cases under middle ear reconstructive surgery and Impedance audiometer assures a superlative means of appraising Eustachain tube function.

Meningioma in the Middle Ear: An Unusual Case of Hearing Loss

Meningioma in the Middle Ear: An Unusual Case of Hearing Loss

Evaluation of Sensorineural Hearing Loss Caused by Drill Burr (Types, Size and Speed of Drilling) In Ipsilateral and Contra Lateral Ear after Middle Ear Surgery

Background and Objective- It has been observed that drilling during ear surgery can lead to noise induced sensorineural hearing loss in diseased and non-operated ear both. Hearing loss is caused by drill noise conducted to the non-operated ear by vibrations of the intact skull. This noise exposure results in dysfunction of the outer hair cells, which may produce hearing loss. Aim of our study is to evaluate the sensorineural hearing loss caused by various types of drill bit, various size of drill bit, speed of in diseased and non-operated ear during ear surgery. Method- Study design was prospective. Hearing assessment of all patients was done by tuning fork test and pure tone audiometry and patients with only mild, moderate and moderately severe conductive hearing loss were selected for study. Patients underwent middle ear surgeries like cortical mastoidectomy, radical mastoidectomy, modified radical mastoidectomy combined approached tympanoplasty and plain tympanoplasty after taking detailed informed consent. All patients underwent post-operative hearing assessment on 10 th post-operative day and after 2 months of operation. Result and Conclusions- Drilling at high speed (rpm) cause more sensorineural hearing loss thus according to our study best speed of drilling is 15000 rpm-25000 rpm. Larger sized burr produces more sensorineural hearing loss.always avoid the use of burrs of more than 7 mm size. We recommend use of <3 mm burr. Cutting burr produces more sensorineural hearing loss than diamond burr.

A cross-sectional study to assess hearing impairment in school going children aged 6 to10 years of Ranchi City

Introduction: Hearing loss of any type or degree if occurs in infancy or childhood can interfere with the development of a childrens spoken language, academic performance, reading and writing skills. The objective of the present study was to determine the prevalence of hearing impairment among school going children aged 6 to10 years of RANCHI city and to identify the etiological factors of diminished hearing and their distribution patterns. Methods: 810 school going children of 6 to 10 years age group selected from four schools of the city. The schools were selected from 208 schools by simple randomization method encompassing children from all socioeconomic backgrounds. Clinical ENT examination was done followed by otoscopy with a portable otoscope and tuning fork tests with 512 Hz tuning fork, both of which were used as screening tests. Pure Tone Audiometry, which is the confirmatory test for hearing impairment and Tympanometry was done only in suspected cases of Otitis media with effusion (OME). Results: A total of 810 children were examined of which 75 had hearing impairment out of which prevalence rate of hearing impairment was significantly more in girls as compared to boys. There was a statistically significant inverse relationship observed between prevalence of hearing impairment and socioeconomic status. Conclusion: Screening tests at school entry levels and ear health care education in community can minimize prevalence of ear pathologies and hence hearing impairment as most of the causes are treatable.

Using Tuning-Fork Tests in Diagnosing Fractures.

Mugunthan K, Doust J, Kurz B, Glasziou P. Is there sufficient evidence for tuning fork tests in diagnosing fractures? A systematic review. BMJ Open. 2014;4(8):e005238. Does evidence support the use of tuning-fork tests in the diagnosis of fractures in clinical practice? The authors performed a comprehensive literature search of AMED, CAB Abstracts, CINAHL, EMBASE, MEDLINE, SPORTDiscus, and Web of Science from each database's start to November 2012. In addition, they manually searched reference lists from the initial search result to identify relevant studies. The following key words were used independently or in combination: auscultation, barford test, exp fractures, fracture, tf test, tuning fork. Studies were eligible based on the following criteria: (1) primary studies that assessed the diagnostic accuracy of tuning forks; (2) measured against a recognized reference standard such as magnetic resonance imaging, radiography, or bone scan; and (3) the outcome was reported using pain or reduction of sound. Studies included patients of all ages in all clinical settings with no exclusion for language of publication. Studies were not eligible if they were case series, case-control studies, or narrative review papers. Potentially eligible studies were independently assessed by 2 researchers. All relevant articles were included and assessed for inclusion criteria and value using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and relevant data were extracted. The QUADAS-2 is an updated version of the original QUADAS and focuses on both the risk of bias and applicability of a study through a series of questions. A third researcher was consulted if the 2 initial reviewers did not reach consensus. Data for the primary outcome measure (accuracy of the test) were presented in a 2 × 2 contingency table to show sensitivity and specificity (using the Wilson score method) and positive and negative likelihood ratios with 95% confidence intervals. A total of 62 citations were initially identified. Six primary studies (329 patients) were included in the review. The 6 studies assessed the accuracy of 2 tuning-fork test methods (pain induction and reduction of sound transmission). The patients ranged in age from 7 to 84 years. The prevalence of fracture in these patients ranged from 10% to 80% using a reference standard such as magnetic resonance imaging, radiography, or bone scan. The sensitivity of the tuning-fork tests was high, ranging from 75% to 92%. The specificity of the tuning-fork tests had a wide range of 18% to 94%. The positive likelihood ratios ranged from 1.1 to 16.5; the negative likelihood ratios ranged from 0.09 to 0.49. The studies included in this review demonstrated that tuning-fork tests have some value in ruling out fractures. However, strong evidence is lacking to support the use of current tuning-fork tests to rule in a fracture in clinical practice. Similarly, the tuning-fork tests were not statistically accurate in the diagnosis of fractures for widespread clinical use. Despite the lack of strong evidence for diagnosing all fractures, tuning-fork tests may be appropriate in rural and remote settings in which access to the gold standards for diagnosis of fractures is limited.