Cochlear implants have a significant impact on the quality of life of older deaf patients, and are a cost-effective intervention in this population. Improvements in speech perception are predictive of gains in health-related quality of life and associated emotional benefits after cochlear implantation.

The SF-36 and RQLQ are good for discriminating rhinitis patients from controls, but the former is poor for detecting changes in QOL. Both are inappropriate for mildly symptomatic patients. Each instrument measures non-overlapping halves of the measurable HRQL. For an assessment of the HRQL in persistent AR that is complete and responsive both instruments should be employed together.

We present two subjects with previously undiagnosed acoustic neuromas who complained of vertigo whenever they ran. One had normal hearing while the other already had a unilateral sensorineural deafness. Hyperventilation for 30 seconds provoked an ipsilateral beating nystagmus and reproduced the vertiginous sensation in both subjects. Hyperventilation is a simple bedside test that should be performed when assessing a subject with vertigo or when there is a clinical suspicion of an acoustic neuroma.

A 66-YEAR-OLD WOMAN had a left acoustic neuroma removed more than 20 years earlier that resulted in a grade VI facial paralysis and anacusis of the left ear. Five years ago, she was diagnosed with a large recurrent tumor and underwent resection via a suboccipital approach. Her medical history was also significant for a Duke B carcinoma of the colon that had been resected several years earlier.She was well until 4 months ago, when she became disorientated and was admitted to a local hospital with fever and neck stiffness. She did not complain of rhinorrhea or otorrhea. Before admission, she had been coughing because of an acute exacerbation of her bronchitis. On physical examination, there was evidence of a suboccipital craniectomy defect. The overlying skin was healthy and the incision had healed well. There were no cranial nerve abnormalities except for those of cranial nerves VII and VIII. A lumbar puncture revealed pneumococcal meningitis.Computed tomographic scans of the head (Figure 1) and temporal bones (Figure 2) were obtained. An exploratory mastoidectomy procedure (Figure 3) was performed after resolution of the meningitis with antibiotic therapy.

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