It is a common misconception that high frequency audiometric notches are diagnostic of noise induced hearing loss. The aim of this study was to identify the prevalence of high frequency notch (HFN) in an audiovestibular medicine outpatient clinic population at a district general hospital. One hundred and forty nine consecutive adult patients were assessed. According to standard practice at the audiovestibular clinic, a full clinical history with particular emphasis on neuro-otological symptoms, noise exposure, and medical risk factors for sensorineural hearing loss was taken. After standard 8-frequency pure tone audiometry, subjects were divided into those with HFN and those without. There were 84 (56%) females and 65 (44%) males with a mean age of 45 years (range: 19 to 91 years). A total of 39.6% had notches not attributable to noise (occupational or recreational) or any other known risk factor. In 29 (49.2%) and 15 (25.4%) the HFN was present in the left and right ear respectively whereas 15 (25.4%) were bilateral. The frequency least affected was 3 kHz while 4 kHz and 6 kHz were affected in almost equal proportions. In 53 ears (71.6%), the notch depth was less than 20 dBHL (10-19 dB) compared to 21 ears (28.4%) with a depth of 20 dBHL or more. This study concludes that high frequency notch without excessive noise exposure or any other known factor is common. It is neither diagnostic of, nor invariable with NIHL unless a convincing history of hazardous noise exposure is elicited from the history.

Introduction:The objectives of this preliminary, prospective, cohort study were to ascertain the characteristics of vestibular evoked myogenic potentials at threshold levels in two groups of Ménière's disease patients – acute and stable – and to identify whether vestibular evoked myogenic potentials can provide any specific, objective information to distinguish acute from stable Ménière's disease.Subjects and methods:The study was based at a tertiary neuro-otology centre. Twenty adult patients who fulfilled the American Academy of Otolaryngology–Head and Neck Surgery1 criteria for Ménière's disease were divided into two groups: 11 patients with acute Ménière's disease and nine patients with stable Ménière's disease. Eighteen healthy adult volunteers served as controls. All subjects underwent vestibular evoked myogenic potential testing with ipsilateral, short tone burst stimuli at 500 Hz, as well as pure tone audiometry. The patients also underwent caloric testing.Results:Vestibular evoked myogenic potentials were present in all controls, and were present in 65 per cent of patients but absent in 35 per cent. The mean absolute threshold (Tvestibular evoked myogenic potential) ± standard deviation in normal controls was 116 ± 7.7 dBSPL; this did not differ statistically from that in patients, nor did it differ between acute and stable Ménière's disease. The p13/n23 latencies at the threshold levels in the normal, acute and stable groups (mean ± standard deviation) were respectively: 15 ± 2.2 ms/23.0 ± 2.5 ms; 15.7 ± 0.9 ms/23.7 ± 0.9 ms; and 15.3 ± 2.0 ms/24.2 ± 1.9 ms. The mean interaural amplitude difference ratio (IAD) ± standard deviation was significantly higher in the stable group compared with the acute group (0.54 ± 0.33 vs −0.15 ± 0.22; p = 0.007) and with the controls (0.54 ± 0.33 vs 0.1 ± 0.22; p = 0.05).Conclusions:The parameter that best differentiated acute from stable Ménière's disease at threshold was the interaural amplitude difference ratio. Therefore, this parameter may be used to monitor the clinical course of Ménière's disease.

Three unrelated children from ethnically diverse backgrounds who were treated for acute leukaemia became profoundly and irreversibly deaf during treatment. Aminoglycoside levels were within the therapeutic range. Genetic testing showed all three to have a maternally inherited mutation of mitochondrial DNA, m.1555A>G, known to cause sensitivity to the ototoxic effects of aminoglycosides. One child has received a cochlear implant, and another will be implanted shortly. Children diagnosed with acute leukaemia should be tested for this mutation at diagnosis, and alternative antibiotics chosen for the treatment of sepsis. Consideration should be given to elective testing of other groups of patients likely to receive aminoglycosides.

Objective To examine the role of salvage intratympanic steroid injections in patients presenting with idiopathic sudden sensorineural hearing loss following a poor response to initial oral steroid treatment. Methods A retrospective analysis of patient records over the course of four years was conducted, and pure tone thresholds were reviewed before treatment, after oral steroid therapy and six weeks after intratympanic steroid injection therapy. Results After oral steroid therapy alone, there was a mean average threshold change of 6.2 dB HL (range, −13.8–33.8 dB). This change was statistically significant for severely affected patients (those with an average presenting threshold of over 71 dB). The mean average threshold improvement following intratympanic steroid injection therapy was 2.9 dB (range, −22.5–61.3 dB); this was not statistically significant. Conclusion Some patients experienced moderate improvement following intratympanic steroid injection therapy; however, no specific subgroup was identified to benefit more from intratympanic steroid injection therapy.