非综合征型耳聋线粒体基因突变的检测

目的：通过分析内蒙古鄂尔多斯市特殊教育学校非综合征型耳聋患者群体中mtDNA 12SrRNA A1555G突变,以探讨该群体与线粒体突变的关系。方法：对鄂尔多斯市特殊教育学校102名非综合征型耳聋患者进行耳聋病因问卷调查、纯音听阈测试、声导抗测试、提取外周血DNA,聚合酶链反应扩增mtDNA目的片段,对扩增片段进行限制性内切酶检测,对阳性标本进行DNA序列分析。结果：该校102名学生中,全部为感音性耳聋,其中54例使用过氨基糖苷类抗生素,7例（6.9%）存在线粒体基因A1555G位点突变。结论：该群体线粒体A1555G位点的突变率高于以往的报道,携带有该突变的个体对氨基糖苷类抗生素有高度易感性,该基因突变是感音神经性耳聋的原因之一。     

糖尿病患者听力及其受累部位的探讨

对43名糖尿病(DM)患者和性别、年龄相配对的非DM患者比较研究发现:DM组平均听闻和AP反应阈显著增高,言语识别最高得分显著减低,脑干听觉诱发电位(BAEP)波峰间潜伏期(IPL)显著延长,重振耳数显著增多;DM患者听力减退发生率为48％(对照组为10％);DM听力减退为双侧对称的感音神经性耳聋,以高频听力损失为主,其受累部位主要在耳蜗,其次蜗后(包括蜗神经和脑干听通道)。     

Noise-induced nitrotyrosine increase and outer hair cell death in guinea pig cochlea

Background Modern research has provided new insights into the biological mechanisms of noise-induced hearing loss,and a number of studies showed the appearance of increased reactive oxygen species (ROS...     

Prevalence of Hearing Loss Among Children 6 to 19 Years of Age: The Third National Health and Nutrition Examination Survey

Context.— Hearing loss in children influences the development of communication and behavioral skills, but few studies in the United States have used pure-tone audiometry to derive hearing loss prevalence estimates for children. Objective.— To describe the prevalence of hearing loss among US children by sociodemographic characteristics, reported hearing loss, and audiometric screening factors. Design.— National population-based cross-sectional survey with an in-person interview and audiometric testing at 0.5 to 8 kHz. Setting/Participants.— A total of 6166 children aged 6 to 19 years completed audiometry in the mobile examination center of the Third National Health and Nutrition Examination Survey conducted between 1988 and 1994. Main Outcome Measure.— Hearing loss, defined as audiometric threshold values of at least 16-dB hearing level based on a low or high pure-tone average. Results.— A total of 14.9% of children had low-frequency or high-frequency hearing loss of at least 16-dB hearing level, 7.1% had low-frequency hearing loss of at least 16-dB hearing level, and 12.7% had high-frequency hearing loss of at least 16-dB hearing level. Most hearing loss was unilateral and slight in severity (16- to 25-dB hearing level). Of those with measured hearing loss, 10.8% were reported to have current hearing loss during the interview. Conclusions.— This analysis indicates that 14.9% of US children have low-frequency or high-frequency hearing loss of at least 16-dB hearing level in 1 or both ears. Among children in elementary, middle, and high school, audiometric screening should include low-frequency and high-frequency testing to detect hearing loss.      

Impairment of recovery of muscle function by residual rocuronium after re-transfusion of intraoperative salvaged blood

Background Recurarization has previously been described in the context of acute normovolemic hemodilution.The aim of this study was to investigate the impairment of recovery of neuromuscular function after re-transfusion of intraoperative salvaged blood in patients treated with rocuronium.Methods We enrolled 50 patients undergoing general anesthesia for lumbar surgery.Intraoperative blood salvage （IBS） was used in 30 patients （group Ⅰ）; the remaining 20 comprised a control group （group C）.Anesthesia was induced with fentanyl,midazolam,propofol and rocuronium.Rocuronium was infused to maintain neuromuscular blockade during surgery.Blood was collected from the operative field and re-transfused in the post-anesthesia care unit （PACU）.Neuromuscular function was monitored using the train-of-four ratio （TOFr）.Once the train-of-four ratio exceeded 90 in the PACU,neuromuscular function was evaluated every 5 minutes for 30 minutes.The TOFr and incremental recovery of TOFr from baseline were recorded.Salvaged blood was re-transfused at the beginning of the evaluation for patients in group Ⅰ,and afterwards for patients in group C.Blood gas analysis was assessed before anesthesia and in the PACU.Results Incremental recovery of TOFr from baseline was significantly less in group Ⅰ than controls at 25 minutes （6.1±3.2vs.9.1±3.2,respectively; P=0.001） and 30 minutes （7.1±3.2 vs.10.0±2.2,respectively; P=-0.001）.There were no significant differences in gas exchange between the groups.Conclusions In patients who had received a rocuronium infusion during anesthesia,re-transfusion of salvaged blood significantly impaired recovery of neuromuscular function recovery in the PACU,but without significant impairment of respiratory function.     

Proliferating cell nuclear antigen involved in the repair process of ouabain-induced brain damage independent of hypertension in rats

Background Ouabain is a mammalian adrenocortical hormone that is involved in the pathogenesis of hypertension by inhibiting Na-K ATPase activity.It also participates in a variety of kinase-mediated signaling pathways associated with Na-K ATPase.Previous studies have shown that ouabain can cause cardiac remodeling independent of elevated blood pressure and that proliferating cell nuclear antigen （PCNA） plays a coordinating role for numerous proteins involved in multiple processes associated with DNA synthesis.Therefore,we hypothesized that ouabain might play a role in the cerebral cortex through signaling pathways independent of hypertension.And PCNA might be involved in this process.Methods Male Sprague-Dawley rats were treated with ouabain or with 0.9% nitric sodium as the control group.Systolic blood pressure was recorded weekly.After four weeks of treatment,morphological changes in the cerebral cortex were analyzed using light and transmission electron microscopy.The expression of PCNA in the cerebral cortex was evaluated by immunohistochemistry,real time quantitative PCR,and Western blotting.Results After 4-week treatment,there was no significant difference in systolic blood pressure compared with the control group,but both structural deterioration and up-regulated expression of PCNA in the brain was induced by ouabain treatment.Conclusions These results suggest that ouabain induces alterations in the brain structure,and this effect is independent of blood pressure.PCNA might be involved in the repair process of ouabain-induced brain damage.     

Association between maternal psychological status and fetal hemodynamic circulation in late pregnancy

Background The prevalence reported of maternal depression from the first to the third trimester was 7.4％,12.8％,12.0％ respectively,which implies that around one-tenth of pregnant women suffer from psychological disorder during the whole pregnancy.It is assumed that during pregnancy the maternal-fetal circulation unit is also affected by maternal psychological status.The aim of this study is to explore the association between maternal psychological status and fetal dynamic blood flow circulation during pregnancy.Methods We recruited 102 singleton low risk pregnant women between 30 to 33 gestational weeks.The Symptom Checklist-90 （SCL-90） was used to assess maternal psychological status.Ultrasound Doppler was used to measure blood flow changes in maternal-fetal circulation.Pulsatility index （PI） value was measured in umbilical artery （UA）,fetal middle cerebral artery （MCA） and maternal uterine arteries （UTA）.Peak systolic velocity （PSV） was measured in MCA and velocity was measured in umbilical vein （UV）.Statistical analysis was performed with standard nonparametric MannWhitney U tests.Two-tailed P values ＜0.05 were considered statistical significance.Results Of the 102 pregnant women,12 patients show high levels of poor mental health.Women with poor mental health have higher umbilical artery PI values than good mental health patients （P=0.020）.A higher MCA PI value is found in poor mental health patients but this does not reach statistical significance （P=0.053）.Women with hostility show lower placental scores （P=0.030）.Women with somatization demonstrate higher values in UA PI,MCA PI and MCA PSV （P=0.049,0.030 and 0.035 respectively）.A higher MCA PSV value is also found in phobic anxiety patients （P=0.046）.Conclusions Poor mental health during pregnancy is found to have an adverse effect on maternal-fetal circulation.Umbilical artery and fetal cerebral circulation are more sensitive and affected by maternal psychological disorder.     

Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery

Background Microscope-integrated near-infrared indocyanine green video angiography （ICG-VA） has been used in neurosurgery for a decade. This study aimed to assess the value of intraoperative indocyanine green （ICG） video angiography with Flow 800 software in cerebrovascular surgery and to discover its hemodynamic features and changes of cerebrovascular diseases during surgery. Methods A total of 87 patients who received ICG-VA during various surgical procedures were enrolled in this study. Among them, 45 cases were cerebral aneurysms, 25 were cerebral arteriovenous malformations （AVMs）, and 17 were moyamoya disease （MMD）. A surgical microscope integrating an infrared fluorescence module was used to confirm the residual aneurysms and blocking of perforating arteries in aneurysms. Feeder arteries, draining veins, and normal cortical vessels were identified by the time delay color mode of Flow 800 software. Hemodynamic parameters were recorded. All data were analyzed by SPSS version 18.0 （SPSS Inc., USA）. T-test was used to analyze the hemodynamic features of AVMs and MMDs, the influence on peripheral cortex after resection in AVMs, and superficial temporal artery to middle cerebral artery （STA-MCA） bypass in MMDs. Results The visual delay map obtained by Flow 800 software had more advantages than the traditional playback mode in identifying the feeder arteries, draining veins, and their relations to normal cortex vessels. The maximum fluorescence intensity （MFI） and the slope of ICG fluorescence curve of feeder arteries and draining veins were higher than normal peripheral vessels （MFI： 584.24±85.86 vs. 382.94_±91.50, slope： 144.95±38.08 vs. 69.20±13.08, P 〈0.05）. The arteriovenous transit time in AVM was significantly shorter than in normal cortical vessels （（0.60±0.27） vs. （2.08±1.42） seconds, P 〈0.05）. After resection of AVM, the slope of artery in the cortex increased, which reflected the increased cerebral flow. In patients with MMD, after STA-MCA bypass, cortex perfusion of corresponding branches region increased and local cycle time became shorter. Conclusion Intraoperative ICG video angiography combined with hemodynamic parameter analysis obtained by Flow 800 software appears to be useful for intraoperative monitoring of regional cerebral blood flow in cerebrovascular disease.     

Gray matter involvement in patients with multiple sclerosis as shown by magnetic resonance imaging

Objective  To summarize the main findings seen on conventional and advanced magnetic resonance imaging (MRI) used to assess gray matter (GM) involvement in patients with multiple sclerosis (MS).

Data sources  The data used in this review were obtained mainly from studies reported in the PubMed database using the terms of multiple sclerosis, gray matter, magnetic resonance imaging. 

Study selection  Relevant literatures on studies of GM involvement in MS patients were identified, retrieved and reviewed.

Results  MS is the most common chronic, disabling central nervous system disease in young adults. Although traditional thinking has considered MS to be a chronic inflammatory demyelinating condition affecting solely the white matter (WM) of the central nervous system, over the last few years it has been shown that GM pathology is also common and extensive. GM demyelinating lesions can not only be found in the cerebral cortex but also in the deep gray nuclei. Apart from focal demyelinated lesions, diffuse neuronal loss and atrophy is also present in the GM of MS patients.

Conclusions  The widespread use of conventional and quantitative MRI based techniques in MS has led to an improved understanding of the mechanisms underlying the inflammatory and neurodegenerative processes of the disease. However, more researches are needed to unravel GM pathology in MS patients, which at present remains enigmatic.     

糖尿病黄斑水肿患者眼底自发荧光观察

Background Diabetic macular edema （DME） is one of the major causes of visual impairment in patients with diabetes mellitus. DME shows a variety of clinical characteristics with unpredictable results to treatment. The purpose of this study was to investigate the characteristics of fundus autofluorescence （FAF） in DME, which is a rapid, noninvasive technique for fundus diseases. Methods A total of 18 patients （30 eyes） with clinically significant macular edema （CSME） were enrolled. FAF imaging was performed with a confocal scanning laser ophthalmoscope. Other ophthalmic examinations included best corrected visual acuity （BCVA）, MP-1 microperimetry, and spectral-domain optical coherence tomography （SD-OCT）. Main outcome measurements included BCVA, macular sensitivity （MS）, central retinal thickness （CRT）, central retinal volume （CRV）, the integrity of the inner segment-outer segment junction （IS/OS）, and the integrity of the external limiting membrane （ELM）. Results Among the 30 eyes, four eyes （13.3%） had normal foveal FAF and 26 eyes （86.7%） had abnormal FAF. Abnormal FAF was mainly divided into three types： cystoid increased FAF （iFAF） 16 eyes （53.3%）, spot iFAF six eyes （20%）, irregular decreased FAF （dFAF） four eyes （13.3%）. According to the FAF morphology, patients were categorized into four groups： normal, cystoid iFAF, spot iFAF, and irregular dFAE There was a significant difference in BCVA （P 〈0.001） and MS （P 〈0.05） among the four groups. The visual function of patients with spot iFAF and irregular dFAF was relatively poor. However, there was no difference in CRT （P=-0.186） and CRV （P=0.191） among the four groups. In the normal FAF group, the photoreceptor layers were mostly intact. Regarding the cystoid iFAF group, the photoreceptor layers were relatively intact, while in the other two groups, IS/OS and ELM were disrupted in most patients. No one had intact IS/OS or ELM layer. Conclusions FAF might reflect the damage of the retina and had a relationship with visual function as well as photoreceptor integrity, which gives new insight into the evaluation of DME. Dynamic FAF monitoring helps to better evaluate the disease progression of DME as well as visual function.     

Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention

Background Cesarean scar pregnancy （CSP） is a very rare but life-threatening entity and there is no optimal management strategy.Here we report a successfully conservative treatment of CSP.Methods We retrospectively analyzed the clinical data of 54 women with CSP,who underwent uterine artery embolization between January 2007 and September 2012 at the Peking University People＇s Hospital.We evaluated the clinical outcomes,the technique and the complications of uterine artery embolization.Results Of the 54 patients,2 patients with hemorrhage after induced abortion received bilateral uterine artery embolization treatment alone,and 52 patients underwent suction curettage after bilateral uterine artery embolization.All 54 women were successfully cured,without any severe complications,and uterine function was restored.During the follow-up,one patient had accidental normal interuterine pregnancy and received induced abortion during the first trimester.Conclution Uterine artery embolization combined with suction curettage is an effective and safe conservative treatment for cesarean scar pregnancy.     

Allergic diseases, immunoglobulin E, and autoimmune pancreatitis: a retrospective study of 22 patients

Background Autoimmune pancreatitis （ALP） is a chronic inflammatory disease of pancreas.We evaluated the clinical manifestations,imaging,and histological presentations of AlP in Chinese patients,and investigated the roles of immunoglobulin E （IgE） and allergic diseases in the diagnosis and pathogenesis of AIP.Methods The clinical records of 22 patients diagnosed with AlP were reviewed and analyzed.All patients with AlP fulfilled the 2006 revised diagnostic criteria proposed by Japan Pancreas Society or the Korean Criteria for AIP.Results Half （11/22） of AlP patients had allergic diseases.Twenty-one patients had elevated serum IgE levels,and 14 patients had IgE levels more than 3 times that of normal.There were no significant differences between the patients with higher or lower IgE,with or without allergic disease,in clinical features,laboratory tests,diffuse or focal lesions,or the choice of treatment methods; however,more complaints of body weight loss were observed in patients with higher IgE levels.Patients with higher IgE levels and with allergic diseases were more likely to have onset in March,April,May,August,September,or October.IgE levels decreased after therapy,but increased again during recurrence.Increased number of mast cells was found in the pancreatic tissue in AIP.Conclusions IgE maybe a useful marker for monitoring therapeutic response and recurrence of AlP.Allergic processes may play an important role in the pathogenesis of AIP.     

Investigation of drugs responsible for perioperative anaphylactic reactions using cellular allergen stimulation test

Background Anaphylactic reactions during anesthesia and operation are common and life threatening.Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs.The purpose of this study was to assess cellular allergen stimulation test （CAST） as a diagnostic instrument in immunoglobulin E （IgE）-and non-lgE-mediated anaphylactic reactions.Methods This study included 25 patients who developed perioperative anaphylactic reactions and 10 subjects that tolerated anesthetics and other drugs during perioperative period from September 2009 to October 2013 in Peking Union Medical College Hospital.We performed skin tests and flow cytometric analysis of basophil activation-based CAST in all subjects.Results Of the 25 patients,17 had IgE-mediated anaphylactic reactions （causative agent identified by skin tests） and 8 had non-lgE-mediated anaphylactic reactions （negative skin tests）.CAST showed a sensitivity of 42.9％,specificity of 90％,and negative predictive value of 80.6％ for neuromuscular blocking agents.Conclusions CAST may be useful for the diagnosis of anaphylactic reactions during perioperative period.Our findings call for further investigation to increase the sensitivity of the test.     

Kinetics of serum HBsAg in Chinese patients with chronic HBV infection with long-term adefovir dipivoxil treatment

Background Knowledge on Hepatitis B surface antigen （HBsAg） kinetics in chronic hepatitis B （CHB） patients with longterm adefovir dipivoxil （ADV） treatment is limited.The aims of this study were to investigate HBsAg kinetics in patients with chronic hepatitis B virus （HBV） infection treated with long-term ADV and to evaluate different characteristics between patients with and without HBsAg loss.Methods We retrospectively evaluated HBsAg kinetics in 24 Chinese patients with chronic HBV infection who achieved continuous virologic suppression during ADV therapy.HBV genotype was determined at baseline.Liver biochemistry,hepatitis B e antigen status,serum HBV DNA,and HBsAg levels were measured at baseline,6 months,and once every year thereafter.Results Of these 24 patients,3,1,and 20 patients were followed up for 3,5,and 6 years,respectively.Baseline serum HBsAg level had a moderate correlation with baseline HBV DNA level （r=0.52,P=0.01）.The median rate of HBsAg reduction during the therapy period was 0.08 Ig IU·ml-1·y-1.Baseline serum HBsAg level was significantly higher than other time points （P ranges from 0.046 to 0.002）.The HBsAg reduction rate during the first year was similar to that in other years （P〉0.05）.The HBsAg reduction rate during the first year in patients with eventual HBsAg loss was significantly faster than that in patients without HBsAg loss （P=0.005）.Conclusions Serum HBsAg levels in Chinese CHB patients receiving long-term ADV demonstrated a gradual reduction.Patients with eventual HBsAg loss had a significantly faster HBsAg reduction rate during the first year than those without HBsAg loss.     

Hemodynamic change in wall shear stress in patients with coronary bifurcation lesions treated by double kissing crush or single-stent technique

Background  Fluid dynamic mechanisms attributed to coronary bifurcation lesions remain a subject of study. The present study aimed at investigating the hemodynamic change of wall shear stress (WSS) in patients with coronary bifurcation lesions treated by double kissing (DK) crush or one-stent with final kissing balloon inflation (FKBI).

Methods  Eighty-one patients with bifurcation lesions treated by stenting who had 3-D model reconstruction were studied. The bifurcation vessels were divided into main vessel (MV), main branch (MB), side branch (SB), and polygon of confluence (POC). MB and SB were classified by internal- and lateral-subsegments, respectively.

Results  The baseline magnitude of WSS in proximal MV, POC-MV, POC-MB, POC-SB and MB-internal segments increased significantly, compared to MB-lateral, SB-internal and SB-lateral. DK crush had the potential of uniformly reducing WSS, turbulent index and the WSS gradient. The WSS value at the POC-SB and SB in the one-stent group remained higher. The turbulent index and WSS gradient between the POC-SB minus the SB-lateral had equal predictive values for in-stent restenosis (ISR).

Conclusion  Fluid dynamic results favor the use of DK crush over the one-stent technique.

     

Perioperative and late outcomes of laparoscopic fundoplication for neurologically impaired children with gastro-esophageal

Background  Persistent gastro-esophageal reflux (GER) due to various pathological factors often results in overt clinical symptoms and signs, which is termed as gastro-esophageal reflux disease (GERD). Affected children usually present with failure to thrive, recurrent pneumonia or apnea. Many neurologically impaired children have symptoms related to GERD. Although laparoscopic fundoplication has been established to be an effective treatment modality for children with GERD, data on its role and long-term efficacy for neurologically impaired patients remain sparse. The aim of this study was to review the results of such patients who underwent laparoscopic fundoplication.

Methods  A retrospective review was performed from 1998 to 2009. All children with neurological impairment who had laparoscopic fundoplication were included.

Results  Fifty-nine GERD patients (male=32, female=27; mean age 6 years) were identified. All subjects showed symptoms of frequent emesis; 32 of them had history of hematemesis (54.2%); 54 had feeding difficulty; 35 (59.3%) had associated respiratory symptoms, including recurrent pneumonia. Gastrostomy was performed concurrently in 39 cases. There was no conversion to open procedure nor was there intra-operative complications and operative mortality. Emesis or hematemesis was controlled adequately in all. However, respiratory symptoms were not controlled in 10 patients (16.9%), and five of them required further respiratory assistance including nasal airway tube and tracheostomy. Clinical recurrence of GERD was not observed in any subject. Twelve patients died during follow-up (range from 3 months to 9 years) due to severe respiratory complications, cardiac arrest, and brain tumor.

Conclusions  Laparoscopic fundoplication is an excellent procedure for controlling clinically significant symptoms in neurological impaired patients with GERD. Further studies are required to assess the improvement of the quality of life in such patients.

     

先天性短指并指畸形:120指璞重建结果分析

Background Symbrachydactyly is defined as a combination of short fingers with syndactyly.There are few published reports estimating the incidence of symbrachydactyly.The aim of this study was to invest...     

氧化损伤在HIV相关神经认知损害中的作用

目的研究由活性氧诱导的DNA氧化损伤在感染了艾滋病毒的患者中枢神经系统组织中的积累。方法利用感染人类免疫缺陷病毒(human immunodeficiency virus,HIV-1)的患者的尸检脑组织的额叶皮质来分析HIV-1亚型,采用免疫荧光染色、定量聚合酶链式反应(polymerase chain reaction,PCR)和PCR克隆测序分析脑细胞中核和线粒体DNA损伤。结果中枢神经系统感染HIV会导致大脑细胞中核和线粒体DNA基因组的损伤。对HIV相关的神经认知功能障碍患者的尸检皮质组织进行检测可以发现有高水平的核和线粒体DNA 8-氧鸟嘌呤(8-hydroxyguanine,8-oxoG)损伤。在HIV相关的神经认知障碍的一个亚型脑组织中有逐渐增加的线粒体DNA突变和缺失,这与病情已经得到控制的情况大为不同。结论在HIV相关的神经认知障碍患者的中枢神经系统中高水平的氧化损伤对HIV引发神经细胞和胶质细胞的神经免疫和凋亡发挥了重要作用。     

Does this patient have hearing impairment?

Akshay Bagai, MD; Paaladinesh Thavendiranathan, MD; Allan S. Detsky, MD, PhD

JAMA. 2006;295:416-428.

Context  Hearing impairment is prevalent among the elderly population but commonly underdiagnosed.

Objective  To review the accuracy and precision of bedside clinical maneuvers for diagnosing hearing impairment.

Data Sources  MEDLINE and EMBASE databases (1966 to April 2005) were searched for English-language articles related to screening for hearing impairment.

Study Selection  Original studies on the accuracy or precision of screening questions and tests were included. Articles that used unaccepted reference standards or contained insufficient data were excluded. Medical Subject Headings or keywords used in the search included hearing loss, hearing handicap, hearing tests, tuning fork, deafness, physical examination, sensitivity, specificity, audiometry, tuning fork tests, Rinne, Weber, audioscope, Hearing Handicap Inventory for the Elderly–Screening version, whispered voice test, sensorineural, and conductive.

Data Extraction  One author screened all potential articles and 2 authors independently abstracted data. Differences were resolved by consensus. Each included study (n = 24) was assigned a methodological grade.

Data Synthesis  A yes response when asking individuals whether they have hearing impairment has a summary likelihood ratio (LR) of 2.5 (95% confidence interval [CI], 1.7-3.6); a no response has an LR of 0.13 (95% CI, 0.09-0.19). A score of 8 or greater on the screening version of the Hearing Handicap Inventory for the Elderly (HHIE-S) has an LR of 3.8 (95% CI, 3.0-4.8); a score less than 8 has an LR of 0.38 (95% CI, 0.29-0.51). An abnormal Weber tuning fork test response has an LR of 1.6 (95% CI, 1.0-2.3); a normal response has an LR of 0.70 (95% CI, 0.48-1.0). An abnormal Rinne tuning fork test response has LRs ranging from 2.7 to 62; a normal response has LRs from 0.01 to 0.85. Inability to perceive a whispered voice has an LR of 6.1 (95% CI, 4.5-8.4); normal perception has an LR of 0.03 (95% CI, 0-0.24). Not passing the audioscope test has an LR of 2.4 (95% CI, 1.4-4.1); passing has an LR of 0.07 (95% CI, 0.03-0.17).

Conclusions  Elderly individuals who acknowledge they have hearing impairment require audiometry, while those who reply no should be screened with the whispered-voice test. Individuals who perceive the whispered voice require no further testing, while those unable to perceive the voice require audiometry. The Weber and Rinne tests should not be used for general screening.