If strict criteria are applied, the rate of false-positive discography may be low in subjects with normal psychometric profiles and without chronic pain. Significantly painful injections were very common in subjects with annular disruption and chronic pain or abnormal psychometric testing.

The authors investigated the impact of unilateral listening upon two central auditory functions: speech discrimination in a noisy environment, and the ability to process and clearly recognize modestly accelerated speech by 30% compression (shortened exposure). We determined that the negative impact of listening to speech in the milieu of noise was individually variable. The data revealed a wide range of impairment, from mild to relatively severe (ie, 0% to 60% [mean, 34%]; normative data, 4% to 36% [mean, 14%]). The performance scores for recognition of compressed sentences were not markedly influenced by unilateral deafness, but the functional results of the residual ear were correlated with a loss of high-frequency sensitivity (mean of 54% correct in severe unilateral deafness with an associated high-frequency loss versus 93% correct in normal controls). Reorganization of the central nervous system by "plasticity" or biological maturation over time failed to improve the performance of monaural listening. The currently recommended methods of remediation for this sensory deficit are discussed, and newer technologies under investigation are examined.

The phenomenon of central presbycusis has been investigated employing a central auditory battery in elderly individuals with essentially normal hearing. The studies indicate a progressive loss in central auditory competence measured by simultaneous binaural challenges and frequency and temporal distortion tests. The rate of failure is related to age, on the whole, but there is increasing variability from the normals with seniority. The hearing disability in noise or speech competitive environments is explained by these data. Auditory disabilities related to poor articulation and rapid speech presentation are identified by other tests in the battery. Central presbycusis, in addition to the peripheral form, does exist and further compounds the hearing disorder in many elderly.

Surgery upon the cervical vertebrae may produce prolonged dysphagia due to regional damage, hemorrhage, infection, and denervation. Cases illustrating these problems are presented with attention to the progression of the clinical course and the diagnostic modalities of radiology and endoscopy. Methods of prevention are emphasized and the therapeutic plan is outlined.

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