In diabetic patients with SSNHL, hearing loss in the contralateral ear and the profound type hearing loss in the lesion ear were commonly noted. The age and PPG level had significant correlations to contra-ear hearing loss. The poor prognosis of sudden deafness in diabetes patients may be caused by preexisting microvascular lesions in the inner ear, and the PPG level could be a risk factor indicator for cochlear dysfunction in diabetic patients. High-dose glucocorticoid should not be contraindicant in diabetic patients with SSNHL. Whether a longer duration of treatment will result in more hearing improvement is worthy of further study.

Associations between the characteristics of general practitioners and their patients with type 2 diabetes O besity is an important cardiovascular risk factor in type 2 diabetes (1). Physician characteristics such as age and sex are related to counseling for overweight (2). Other physician characteristics may also be related. Patients indicated greater confidence in nonobese versus obese physicians. Whether this translates into increased success in obesity management is unknown (3). We aimed to study associations between the weight of general practitioners and their type 2 diabetic patients.A postal survey was performed among 36 general practitioners participating in a shared-care diabetes project in 2000. It contained questions about the general practitioners' age, sex, weight, height, smoking behavior, work experience, practice population size, and opinion regarding how much influence they have on a patient's weight and smoking cessation. The project's target population consisted of type 2 diabetic patients who were exclusively treated in primary care. Patients who were cotreated in secondary care or who were terminally ill or had dementia were excluded. Participating patients (n ϭ 1,441) represented 87% of the target population. Data on patient age, sex, diabetes duration, BMI, and smoking were collected by nurses. We performed a regression analysis with the mean BMI of patients as the dependent variable and the above variables as predictors.The survey response rate was 100%. Most general practitioners were nonsmoking (94%) men (83%) with a mean (ϮSD) age of 51.1 Ϯ 7.0 years and work experience of 18.1 Ϯ 8.9 years. The general practitioners' mean BMI was 24.4 Ϯ 3.5 kg/m 2 (BMI Ͻ25 in 72%). For patients (per general practitioner), mean age was 68.2 Ϯ 2.9 years, diabetes duration 7.2 Ϯ 1.3 years, and BMI 29.3 Ϯ 0.85 kg/m 2 ; 44 Ϯ 9% were men. The mean BMI of patients showed the strongest correlation with the BMI of general practitioners: Ϫ0.40 (partial correlation) and unstandardized coefficient B of Ϫ1.05 (95% CI Ϫ0.197 to Ϫ0.013). The optimal model (P ϭ 0.07) had a multiple correlation (R) of 0.56, and explained variance (R 2 ) was 31% (adjusted 17%). We found a negative correlation between the BMI of type 2 diabetic patients and their general practitioners. Obese doctors had lean patients. Our study is limited by the cross-sectional design; associations were found, not causal relations.Hash et al. (3) showed that patients indicated greater confidence in nonobese physicians. However, we found no translation into increased success in obesity management. On the contrary, patients of nonobese general practitioners had a higher BMI compared with patients of obese general practitioners. A discernable negative impact of patient weight on physician behavior was shown earlier (4). Could it be that nonobese general practitioners lack motivation to treat overweight patients? Is it time for general practitioners to search our own hearts? • LIELITH J. UBINK-VELTMAAT, MD Sudden sensorineural hearing loss (SSNHL) is define...

Multiharmonic optical microscopy has been widely applied in biomedical research due to its unique capability to perform noninvasive studies of biomaterials. In this study, virtual biopsy based on back-propagating multiple optical harmonics, combining second and third harmonics, is applied in unfixed rat tympanic membrane. We show that third harmonic generation can provide morphologic information on the epithelial layers of rat tympanic membrane as well as radial collagen fibers in middle fibrous layers, and that second harmonic generation can provide information on both radial and circular collagen fibers in middle fibrous layers. Through third harmonic generation, the capillary and red blood cells in the middle fibrous layer are also noted. Additionally, the 3-D relationship to adjacent bony structures and spatial variations in thickness and curvature are obtained. Our study demonstrates the feasibility of using a noninvasive optical imaging system for comprehensive evaluation of the tympanic membrane.