The Otolaryngology Consultant Workforce in England: A Survey Update and Future Repercussions.

INTRODUCTION: Effective medical staffing is pivotal for a successful healthcare system, demanding strategic planning to ensure a high-quality service. Although the UK's doctor to population ratio has improved over time, it remains below global averages. The COVID-19 pandemic has exacerbated existing challenges, resulting in an unprecedented NHS waiting list with Ear, Nose, and Throat (ENT) surgeries ranking third highest in waiting times amongst all specialties. METHODS: This study utilized a national jotform survey to gather data from ENTUK members, primarily focusing on consultant staffing within ENT departments across the UK. Additional information collected encompassed registration status, part-time roles, gender, vacancies, locum roles, associate specialists, registrars and other junior doctors, and advanced nurse practitioners. When survey responses were inadequate, direct communication was established with departmental consultants or secretaries, followed by Freedom of Information requests as necessary. All data were compiled using Microsoft Excel. RESULTS: Among the 65 responses to the ENTUK survey, 53 individual trusts were identified. These included 41 English acute trusts, with supplementary participation from Scotland, Wales, and Northern Ireland. Data from 749 consultants across 115 English acute trusts were collected in combination with a Freedom of Information request. CONCLUSION: Despite an increased number of ENT consultants, the persistence of unfilled posts coincides with mounting waiting lists. The pandemic's effects, including early retirements and part-time roles, emphasise the urgency of expanding training positions to counterbalance these shifts. Local and national interventions are essential to fortify and diversify the ENT workforce through a variety of strategies.

Bullying at work and work-related stress in healthcare workers: a cross sectional study.

BACKGROUND: Bullying is a serious and growing problem affecting a significant proportion of healthcare professionals, a professional category exposed to work-related stress. Workplace bullying has been defined as a set of negative behaviours consisting in harassment, offense or negative influence on work that are directed to the members of the organization and that occur regularly and repeatedly over a period, becoming part of the context of work. STUDY DESIGN: We performed a cross-sectional study using the HSE questionnaire and defining the sample size considering the number of healthcare workers of a big hospital and then calculating it with EpiInfo™ software. 191 people have been enrolled. METHODS: The study was divided into three steps. The first one to identify, among the workers, those who were exposed to bullying at work and those who were not. The second one has been aimed at assessing the presence of work-related stress through the administration of the HSE questionnaire. The third step has been aimed at performing the statistical analysis of the data. For each single domain explored by the questionnaire the score obtained was treated as a linear variable and the median and interquartile range (IQR) was calculated. After, a non-parametric analysis (Wilcoxon rank-sum test) was performed in order to define the statistical significance of the observed differences. RESULTS: All the 191 questionnaires were self-administered by the Health Care Workers under study and correctly filled in without any multiple or missing responses. Considering the scores obtained to question n. 21, that investigates "bullying at work", we obtained two groups: High-Exposure Group (total, males and females), and Low-Exposure Group (total, males and females). In the High-Exposure Group, two critical domains were found: Demands and Control (total, male and female samples). The differences with the Low-Exposure Group were statistically significant. In the Low-Exposure Group the critical domain was Manager Support (total and female samples). The differences with the High Exposure Group were not statistically significant. CONCLUSION: This study aimed to show how the exposure to bullying can influence the perception of psychosocial risks. It seems that the workers most exposed to bullying also have worse scores on the HSE questionnaire, particularly for two domains: Demands and Control. That is consistent with the most recent scientific literature.

Working over 5,000 m: medical check-up.

Any work activity performed at elevations over 3,000 m above sea level is considered as work at high altitude. The changing environmental conditions result in an adaptation of the human organism, mainly due to a reduced partial pressure of oxygen in the air and a proportional decrease in barometric pressure. We carried out a systematic review of the scientific literature in this field so as to develop a health and risk protocol as well as a procedure of ascent for researchers and staff expected to work in a science research lab at an altitude of 5,100 m asl. We wish to highlight the crucial role that occupational medicine plays in the formulation of a medical protocol used to assess the suitability of staff to work in environments posing high risks to human health, as in this case, and of a protocol of ascent minimizing the risk associated with changes in altitude.

Italy and Argentina compared: an epidemiological study of occupational diseases.

BACKGROUND: The research presented in this paper analyses the clinic-pathological manifestations and work-related health risks identified among outpatients treated in the hospitals of Rome and Buenos Aires. MATERIALS AND METHODS: The occupational anamnestic data were collected between 2013 and 2014 through questionnaires with specific items aimed at detecting occupational diseases classified by target organ systems in outpatient clinics of cardiology, dermatology, physical medicine, ophthalmology, orthopedics, endocrinology (thyroid and gonads). An inferential statistical analysis was then carried out to evaluate the relationship between nationality, exposure to occupational risks and the prevalence and incidence of the selected pathologies. An univariate statistical analysis was performed for this purpose and, in the case of statistically significant results, a subsequent multivariate analysis was used to evaluate the incidence of occupational risk factors and nationality on the pathology diagnosed in conjunction with other confounding factors such as smoking habits and gender. The total sample consisted of 1090 subjects of both sexes. Risks were grouped into seven categories and diseases into 12 diagnostic groups. We analyzed the correlation between risks and diseases with respect to hospital outpatients and to the total sample then comparing Argentina and Italy's data. RESULTS: Analysis of data revealed a higher prevalence of hypertension and dysmetabolic disorders for DSE (Display Screen Equipment) workers both in Italy and Argentina; however, multivariate analysis showed that smoking represents a confounding factor for this association. A higher prevalence of allergic contact dermatitis (ACD) was found in the population samples of Rome and there appeared to be a correlation between eye disorders/defects and Argentine data source. CONCLUSIONS: Our study suggests the usefulness of collecting occupational anamnestic data from outpatient departments to highlight possible associations between occupational risks, lifestyles and pathologies, so as to implement the appropriate prevention strategies.

Liver damage in automotive and industrial workers of the glass.

OBJECTIVE: High doses of organic solvents can cause hepatic disease. We investigated whether exposure to low doses of solvents in automotive and industrial workers may lead to changes in liver tests. METHODS: We studied the liver parameters (glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamma-glutamyl-traspeptidasi (γ-GT), alkaline phosphatase (PHA), total (TB) and direct bilirubin (DB) of 24 workers exposed to organic solvents and of 30 unexposed controls. RESULTS: A significant increase of GOT, GPT and γ-GT was found in exposed workers compared to unexposed controls workers. The ratio GPT/GOT was significantly higher among the exposed compared to controls. CONCLUSIONS: The results confirmed the hypothesis that exposure to low doses of solvents may determine a liver damage.

Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study.

OBJECTIVE: The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents. MATERIALS AND METHODS: The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses. RESULTS: 379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85. CONCLUSIONS: Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

Relationship between occupational exposure to cadmium, transaminases and γ-GT in workers exposed to urban stressors.

BACKGROUND: The exposure to Cd has been linked to many disease and liver is the major target organ of Cd toxicity following acute or chronic exposure.No study has ever evaluated the association between liver function tests and exposure to Cd present in urban air in outdoor workers. MATERIALS AND METHODS: In order to assess the relationship between the exposure to urban Cd and the associated changes in liver functionality markers, we conducted a study on 110 municipal policemen divided into 2 groups according to their tasks: 60 traffic policemen and 50 drivers, underwent tests for the determination of the urinary values of Cd correlated with the blood levels of transaminases and ?-GT. Moreover we investigated the exposure to Cd in the air through a personal dosimetry on a subgroup of 40 subjects (20 traffic policemen 20 police drivers). RESULTS: The results showed that the average personal exposure to air Cd was significantly higher in traffic policemen than drivers. Furthermore, in the subset of 40 subjects and in the total sample of 110 subjects, the mean values of urinary Cd were significantly higher in traffic policemen rather than in the police drivers. No significant difference was observed in the mean values of liver functionality in both groups. CONCLUSIONS: Due to the few studies on the effects of the exposure to Cd in big cities, the results of the present study offers useful information about occupational exposure to Cd on the road and in the car and the lack of effects on liver function.

Professional exposure to ionizing radiations in health workers and white blood cells.

BACKGROUND: The aim of this study is to estimate if low dose of occupational exposure to ionizing radiations can cause alterations of plasma concentrations of total white blood cells, lymphocytes, monocytes and granulocytes (eosinophils, basophils, neutrophils), in the health workers of a big hospital. METHODS: 266 non smokers subjects of both sexes (133 health workers and 133 controls) were included in this study, compared on the basis of sex, age and working seniority. The complete blood count (CBC) was performed in all included workers. RESULTS: The differences between the mean values were compared using Student T-test for unpaired data. The frequencies of the single variables were compared using Chi (2) test with Yates correction. The differences were considered significant when the P values were < 0.05. The mean values and the distribution of the mean values of total white blood cell were significantly decreased in health workers of both sexes compared to controls. The average values of granulocytes neutrophils were significantly low in female health workers compared to female controls. CONCLUSIONS: The obtained results suggest that low dose of occupational exposure to ionizing radiations is able to influence some lines of the hematopoietic system in exposed workers.

Perceived stress and stress-related parameters.

BACKGROUND: The purpose of this study is to evaluate, using a questionnaire developed by our research group, whether occupational exposure to physical, chemical and psychosocial urban stressors can lead to alterations in perceived stress in a group of both male and female outdoor workers. The study also examines possible correlations between the levels of stress as inferred from the scores of the questionnaire and the levels of certain stress-related parameters (prolactin levels, consumption of coffee, chocolate, alcohol and cigarette smoking). METHODS: We evaluated a final sample of 480 subjects (342 male and 138 female). All workers included in the study were divided into three groups on the basis of scores of the questionnaire. RESULTS: About 60% of workers showed a moderate or severe stress condition, with a statistically significant prevalence of female workers and younger subjects. There was a statistically significant correlation between the questionnaire score and the mean levels of stress-related parameters. The increase of perceived stress increases significantly the mean levels of prolactin and the consumption of coffee, chocolate and cigarettes. There was no statistically significant differences for alcohol consumption. CONCLUSIONS: The results show that exposure to chemical physical and psycho-social urban stressors can influence perceived stress in outdoor workers. The questionnaire used in our research could be an useful instruments for physicians during the health surveillance visits

The impact of coronavirus disease 2019 on suspected head and neck cancer two-week-wait referrals.

BACKGROUND: The impact of coronavirus disease 2019 extends far beyond the immediate burden on healthcare systems caused by hospitalisation of patients with the disease itself. OBJECTIVE: To investigate the impact of the coronavirus disease 2019 pandemic on the referral rate of patients to the suspected head and neck cancer two-week-wait clinic. METHODS: A multicentre retrospective study was performed investigating data collected for all patients attending the suspected head and neck cancer two-week-wait clinic in ENT departments in the West Midlands. RESULTS: A total of 509 fast-track referrals were received from February to April in 2019, compared to 399 referrals in 2020. April 2020 saw a 62.4 per cent reduction in referral rate compared to April 2019. CONCLUSION: The coronavirus disease 2019 pandemic has resulted in changes to health-seeking behaviours, and healthcare provision and delivery. Urgent policy interventions may be required to compensate for the hidden impact that the coronavirus disease 2019 pandemic has had on those with cancer.

Telework and its effects on mental health during the COVID-19 lockdown.

OBJECTIVE: During the Covid-19 pandemic, many governments promoted the adoption and development of telework to reduce some of the consequences of the current health crisis on the economy and favor social distancing. The aim of this web-based cross-sectional study was to assess the consequences of the Covid-19 pandemic on job organization, exploring the effects of lockdown measures on the psychological distress and perceived well-being of workers experiencing telework. SUBJECTS AND METHODS: A web-based cross-sectional survey has been used to collect data. The participants answered the questionnaire from April 1 to April 30, 2020. The questionnaire consisted of three sections, which investigated: 1) demographic and occupational variables, 2) lifestyle and habits variables, 3) psychological distress and perceived well-being. The General Health Questionnaire (GHQ-12) has been used to evaluate psychological distress and the 5-item World Health Organization Well-Being Index (WHO-5) to explore subjective well-being. RESULTS: Psychological distress was associated with educational level, with habits, and with reporting poor well-being. Poor well-being was associated with a higher job demand during pandemic, lifestyle and habits variables, and psychological distress. CONCLUSIONS: This is one of the first studies exploring the consequences of the COVID-19 pandemic and lockdown measures on the perceived well-being and psychological distress of workers experiencing telework. It is mandatory to pay more and more attention to the mental health of teleworkers, considering the increasing diffusion and adoption of this type of work organization.

Work-related stress risk and preventive measures of mental disorders in the medical environment: an umbrella review.

OBJECTIVE: Work-related stress (WRS) is widespread among medical doctors. WRS not only affects the physician's mental and physical well-being, but also patient care quality and the overall efficiency of the healthcare system. The aim of this study is to conduct a systematic review of the current preventive measures against mental disorders, work-related stress, and burnout among physicians. MATERIALS AND METHODS: The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools: INSA, Newcastle Ottawa Scale, JADAD scale, and AMSTAR. English publications only were selected. No restrictions applied for publication type. Reviewers excluded articles not concerning the following topics: WRS prevention, WRS risk factors and mental disorders among physicians. Reviewers also excluded findings of less academic significance, editorial articles, individual contributions, purely descriptive studies published in scientific conferences. RESULTS: Online search returned 4748 references on the following databases: PubMed (1638), Scopus (3108) and Cochrane Library (2). 36 studies were included in this review (thereof, 13 reviews and 23 original articles). Narrative reviews were rated on the INSA scale. The mean, median, and modal rating was 6. This indicates an intermediate-high quality of these studies. Systematic reviews were rated on the AMSTAR scale. The mean and median rating was 9, and the modal rating was 8. This indicates a high quality of these studies. The scores assigned to the original articles have a mean, median, and modal rating of 7. This also indicates an intermediate-high quality of these studies. CONCLUSIONS: Work-related stress and mental disorders seem to be widespread among medical practitioners. It is already a priority to adopt preventive measures against these phenomena. However, there is still no consensus on what the most effective measures are. Additional research is needed to formulate evidence-based recommendations.

Work-Related Stress Questionnaire (WRSQ): a new tool to assess psychosocial risks at workplaces.

INTRODUCTION: Work-related stress (WRS) can harm both physical and mental health but it shouldn't only be considered in its negative sense. The evaluation of WRS cannot be separated from the analysis of the subjective perception of workers, usually made by questionnaires. The aim of this pre-pilot study is to identify a new questionnaire capable of exploring as many psychosocial risk domains as possible and with a high internal consistency. MATERIAL AND METHODS: A first version of the questionnaire was administered to a convenience sample selected on a voluntary basis; both socio-demographic and work-related data were collected. A single item test was conducted on a group of 50 workers in order to assess whether the questions were confusing and to understand if they could be improved. The study sample completed the questionnaire at time 1 and time 2 (after 3 days). The 33-item version of the questionnaire was web-based in Google Form. Cronbach's alpha and Pearson's r were calculated. RESULTS: The analysis of the 33-item questionnaire at time 1 shows an excellent reliability with Cronbach's alpha coefficients of 0.93. At time 2 Cronbach's alpha coefficients was 0.94. Based on the test-retest score, the items with the highest scores were selected as part of the final version of the questionnaire (10-item). The reliability of this 10-items version is high with a Cronbach's alpha coefficients of 0.86 both at time 1 and at time 2. Two items have been chosen to explore the "emotional demand" and "dealing with technology". CONCLUSIONS: The pre-pilot study provided a questionnaire with high reliability and high repeatability. In its final version, the questionnaire investigates different psychosocial risk domains and represents a possible useful tool for assessing worker's exposure to them. The Authors reserve to administer the questionnaire to a larger population.

Limits of internal fixation in long-bone fracture.

Alternatives to internal fixation of long-bone fracture comprise, depending on location, external fixation or joint replacement. Limitations comprise risk of infection and functional outcome quality, which vary according to technique. The present study examines these limitations, based on comparative or large-scale studies from which certain significant results emerge. Four main questions are dealt with: (1) the present role of locking plates; (2) conditions for intramedullary nailing in Gustilo grade IIIb open fracture; (3) the limitations of conversion from external fixation to intramedullary nailing in open lower leg fracture; (4) and the limitations of definitive anterograde femoral nailing in multiple trauma. Locking plate fixation has yet to prove clinical superiority in any of the anatomic sites for which good-quality comparative analyses are available. Infection risk in Gustilo grade IIIb open lower leg fracture is equivalent when treated by intramedullary nailing or external fixation, if wound care and debridement are effective, antibiotherapy is initiated rapidly and skin cover is restored within 7days. Conversion from primary external fixation to intramedullary nailing is possible if the external fixator was fitted less than 28days previously and skin cover was restored within 7days. The pulmonary and systemic impact of peripheral lesions or definitive anterograde intramedullary nailing of femoral fracture in multiple trauma calls for caution and what is known as "damage-control orthopedics" (DCO), a term covering the general consequences of both the initial trauma and its treatment. Femoral intramedullary nailing is thus contraindicated in case of hemorrhagic shock (blood pressure<90mmHg), hypothermia (<33°C), coagulation disorder (platelet count<90,000) or peripheral lesions such as multiple long-bone fractures, crushed limb or primary pulmonary contusion. In such cases, external fixation or retrograde nailing with a small-diameter nail and without reaming are preferable.

Functional consequences of the first reported mutations of the proto-oncogene PTTG1IP/PBF.

Pituitary tumor-transforming gene 1-binding factor (PTTG1IP; PBF) is a multifunctional glycoprotein, which is overexpressed in a wide range of tumours, and significantly associated with poorer oncological outcomes, such as early tumour recurrence, distant metastasis, extramural vascular invasion and decreased disease-specific survival. PBF transforms NIH 3T3 fibroblasts and induces tumours in nude mice, while mice harbouring transgenic thyroidal PBF expression show hyperplasia and macrofollicular lesions. Our assumption that PBF becomes an oncogene purely through increased expression has been challenged by the recent report of mutations in PBF within the Catalogue of Somatic Mutations in Cancer (COSMIC) database. We therefore sought to determine whether the first 10 PBF missense substitutions in human cancer might be oncogenic. Anisomycin half-life studies revealed that most mutations were associated with reduced protein stability compared to wild-type (WT) PBF. Proliferation assays narrowed our interest to two mutational events which significantly altered cell turnover: C51R and R140W. C51R was mainly confined to the endoplasmic reticulum while R140W was apparent in the Golgi apparatus. Both C51R and R140W lost the capacity to induce cellular migration and significantly reduced cell invasion. Colony formation and soft agar assays demonstrated that, in contrast to WT PBF, both mutants were unable to elicit significant colony formation or anchorage-independent growth. However, C51R and R140W retained the ability to repress radioiodide uptake, a functional hallmark of PBF. Our data reveal new insight into PBF function and confirm that, rather than being oncogenic, mutations in PBF are likely to be passenger effects, with overexpression of PBF the more important aetiological event in human cancer.

Elevated PTTG and PBF predicts poor patient outcome and modulates DNA damage response genes in thyroid cancer.

The proto-oncogene PTTG and its binding partner PBF have been widely studied in multiple cancer types, particularly thyroid and colorectal, but their combined role in tumourigenesis is uncharacterised. Here, we show for the first time that together PTTG and PBF significantly modulate DNA damage response (DDR) genes, including p53 target genes, required to maintain genomic integrity in thyroid cells. Critically, DDR genes were extensively repressed in primary thyrocytes from a bitransgenic murine model (Bi-Tg) of thyroid-specific PBF and PTTG overexpression. Irradiation exposure to amplify p53 levels further induced significant repression of DDR genes in Bi-Tg thyrocytes (P=2.4 × 10-4) compared with either PBF- (P=1.5 × 10-3) or PTTG-expressing thyrocytes (P=NS). Consistent with this, genetic instability was greatest in Bi-Tg thyrocytes with a mean genetic instability (GI) index of 35.8±2.6%, as well as significant induction of gross chromosomal aberrations in thyroidal TPC-1 cells following overexpression of PBF and PTTG. We extended our findings to human thyroid cancer using TCGA data sets (n=322) and found striking correlations with PBF and PTTG expression in well-characterised DDR gene panel RNA-seq data. In addition, genetic associations and transient transfection identified PBF as a downstream target of the receptor tyrosine kinase-BRAF signalling pathway, emphasising a role for PBF as a novel component in a pathway well described to drive neoplastic growth. We also showed that overall survival (P=1.91 × 10-5) and disease-free survival (P=4.9 × 10-5) was poorer for TCGA patients with elevated tumoural PBF/PTTG expression and mutationally activated BRAF. Together our findings indicate that PBF and PTTG have a critical role in promoting thyroid cancer that is predictive of poorer patient outcome.

Proximal ulnar fractures in adults: a review of 163 cases.

The aim of this study was to report the epidemiological characteristics and the experience of 5 departments of trauma, in France, in the management of fractures of the proximal ulna. 163 patients with fractures of the proximal ulna with a mean age of 49.9 years (range 16-97) were managed. The most common mode of injury was a motor vehicle collision (48%). 18% sustained associated injuries to the ipsilateral limb. Open fractures were present in 42 patients (25%). A total of 109 patients had a fracture of the olecranon, with the Mayo 2A and B types most frequently seen (66%). The patients were invited for clinical examination at a mean duration of 16 months, retrospectively. Validated patient-oriented assessment scores involving the Mayo Elbow Performance Index (MEPI) and the Broberg and Morrey score were evaluated. All patients had follow-up radiographs. The mean arc of elbow motion was 130° (70-150°). The mean MEPI was 91 (20-100) with good results in 23% and excellent results in 52% of the patients. The mean Broberg and Morrey score was 90 after isolated olecranon fracture, and decreased with the complexity of the lesion. 117 fractures (72%) healed with ulnohumeral congruity. 9 fracture non-unions occurred (6%). Although the fracture of the proximal ulna can be described in several classifications, none of them accommodate it satisfactorily, because of the complexity of the lesion. The coronoid process is the keystone for the stability of the elbow. It forms the anterior buttress with the radial head. Tension band wire fixation is by far the commonest technique of internal fixation used for the treatment of non-comminuted olecranon fractures. Dorsal plate fixation is a useful option by providing improved fixation of complex comminuted fractures and fracture-dislocations. The radiocapitellar joint has to be restored appropriately, preserving the radial head when possible and replacing it with a prosthesis otherwise. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. In addition, a brief period of hinged external fixation should be considered.

Early diagnosis of hearing loss: otoacoustic emissions evoked by distortion products and pure-tone audiometry: Preliminary findings.

OBJECTIVE: Literary studies underline the effectiveness of distortion product otoacoustic emissions (DPOAEs), which are not affected by the collaboration of the subject examined, in the early diagnosis of hearing loss. Aim of the study is to compare the objective technique of DPOAEs with respect to the pure-tone audiometry in early diagnosis of hearing loss. MATERIALS AND METHODS: The clinical research was carried out on 852 workers. All subjects underwent pure-tone audiometry, tympanometry and distortion products. RESULTS: The results show: a) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries in the studied samples; and, after division by gender: b) a prevalence of subjects with impaired DPOAEs higher than the prevalence of subjects with impaired audiometries only in men; c) a prevalence of impaired DPOAEs and of impaired audiometries in men higher than in women. CONCLUSIONS: The results suggest the higher effectiveness of DPOAEs compared to pure-tone audiometry in making an early diagnosis of hearing loss.

[Severe anterior sprains of the knee. Ligamentoplasty using the patellar tendon and reinforcement]. / Entorses graves antérieures du genou. Ligamentoplastie au tendon rotulien avec renfort.

One hundred four severe knee sprains, treated by ligamentoplasty, according to Marshall-MacIntosh, with a Kennedy polypropylene ligament augmentation device, were reviewed with an average follow-up of 31 months. The functional result was evaluated as good or excellent in 3 out of the 4 cases; 87% of the sportsmen were satisfied. The result was unsatisfactory in 26% of the cases, with rupture or an elongation of the transplant in 9 cases (8.6%), due for some patients to premature resumption of sports; in 4 cases reoperation was necessary. A failure is always possible, even with an augmentation; however, with a ligament augmentation device, early rehabilitation and sports are possible (after an average of 6 months). There was no intolerance: 2 cases of synovitis, with a rupture, were observed. The authors underscore the ill effects of a delay between the accident and the stabilization, which causes numerous lesions of the menisci and the cartilage. This is generally admitted in the literature. The ligament augmentation device has been used for 3 years; the operation is performed after the acute phase of the first lesions and at the latest during the first year after the injury, before secondary lesions of the menisci occur.