Expensive investigations are rarely helpful in dizzy elderly people. The cause of the dizziness can be diagnosed in most cases on the basis of a thorough clinical examination without recourse to hospital referral.

No abstract

Twenty six patients with Bell's palsy were studied at presentation using electroneurography. Ninety-four per cent of those who recovered completely could have been predicted by ENoG within 10 days of onset. Of the 18 patients who recovered completely, 13 had a total palsy at presentation.

Previous work by our group questions the validity of existing electronystagmography (ENG) reference ranges in the elderly. We aim to establish valid reference ranges for ENG in people over 65 on the Nicolet Nystar Plus system. Ninety-six healthy asymptomatic subjects over 65 underwent ENG, including spontaneous and positional nystagmus, saccades, smooth pursuit, optokinetic nystagmus and bithermal calorics; 95% reference ranges with confidence intervals were calculated. The newly determined reference ranges were far wider than those provided by the ENG equipment manufacturer for eight out of 11 parameters (all P < 0.001). Vestibular function is known to deteriorate and become more variable with age. The failure to reflect this change in currently used reference ranges may have contributed to the high rates of vestibular disease reported in some series of dizzy elderly patients. Clinical interpretation of ENG depends on valid reference ranges.

The following hypothesis is presented: that the susceptibility of an individual patient to hearing loss as a result of cis-platinum administration can be predicted on the basis of eye colour. The rationale is that the melanin content of the inner ears is related to that of the eyes; dark eyes contain more melanin than lightcoloured eyes; and melanin causes the accumulation of the ototoxic drug within the inner ear. Hence those with dark eyes will suffer greater damage to the hearing than those with pale eyes. An investigation that confirmed this hypothesis is reported. In addition to cochlear damage there is a significant likelihood of damage to the auditory nerve as a result of the treatment.