The modified Romberg Balance Test: normative data in U.S. adults.

OBJECTIVE: To generate normative values for performance on the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces stratified by age, sex, and race/ethnicity and to determine fall risk associated with different levels of performance. STUDY DESIGN: National cross-sectional survey. SETTING: Ambulatory examination centers. PATIENTS: U.S. adults 40 years and older who participated in the 2001-2004 National Health and Nutrition Examination Survey (n = 5,086). INTERVENTIONS: Time to failure on the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces. MAIN OUTCOME MEASURES: History of falling in the previous 12 months. RESULTS: We observed that the time to failure decreased with increasing age across all sex and race/ethnicity categories. We found that once individuals went below a time to failure of 20 seconds, there was a significant greater than 3-fold increase in the odds of falling. In general, participants crossed the 20-second threshold at the age of 60 to 69 years. CONCLUSION: We established nationally representative normative values for performance on the modified Romberg test and noted differences in the rates of change across demographic groups. In addition, we demonstrated the fall risk associated with different levels of performance. These data will aid the clinician in interpreting and risk stratifying their patient's performance on this postural test.

Developing the next generation of otolaryngologist-researchers.

The lifeblood of any specialty is innovation and discovery. It is important for the field of otolaryngology and its patients that we identify, recruit, train, and develop the next generation of researchers in otolaryngology. This article describes programs and resources currently available to otolaryngologists in training and early in their career for their development as clinician-scientists. We describe the background of the current generation of National Institutes of Health-funded otolaryngologists and discern where the next generation might come from. Special attention is given to the National Institute on Deafness and Other Communication Disorders, which focuses on supporting research and research training in hearing, balance, smell, taste, voice, speech, and language, and to programs aimed at the development of clinician-scientists.

Sensorineural hearing loss in Vogt-Koyanagi-Harada syndrome.

BACKGROUND: Vogt-Koyanagi-Harada (VKH) syndrome is a systemic condition characterized by ocular inflammatory disease as well as skin, ear, and meningeal manifestations. Patients with VKH often report tinnitus and hearing loss, but these symptoms tend to be given secondary consideration because most undergo treatment with steroids to prevent blindness resulting from granulomatous uveitis, exudative retinal detachment, and optic nerve inflammation. METHODS/STUDY DESIGN: In the current retrospective review, 24 patients with this syndrome were screened for auditory system abnormalities. All patients denied history of noise exposure or ototoxic agent exposure. The age range of the patients was 13 to 42 years. RESULTS: Three patients reported tinnitus and two patients reported sudden hearing loss. One patient experienced vertigo and aural fullness. Eight of 24 patients had pure-tone thresholds greater than 25 dB hearing loss at two or more frequencies. Five of 24 of these patients experienced hearing loss outside of the 95% confidence interval for published age-matched control populations. There was sloping sensorineural hearing loss at 4 kHz and above in five of 24 patients. All eight patients with hearing loss experienced some degree of hearing loss at 4 kHz or above. Three patients had mild to moderate low-frequency sensorineural hearing loss. There were no tympanometric abnormalities suggestive of conductive involvement. Abnormal acoustic reflex decay was observed in one patient. CONCLUSIONS: We conclude that a significant number of patients with VKH experience sensorineural hearing loss and that every patient with VKH should undergo a review of systems for auditory abnormalities and referral for audiologic testing if symptomatic. It is possible that untreated patients may experience worse symptoms.