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Background. There is plenty of evidence that survival time associated with advanced ovarian cancer is predominantly related to the amount of residual tumor after primary operation. However, there are only few and inconclusive reports concerning the effect of second debulking procedures on survival time after relapse. Methods. To evaluate the effect of radical second operation, 30 patients with clinically diagnosed relapses had second operations after a median recurrence‐free interval of 16 months, considerable efforts were made to resect all tumor tissue. Complete resection was achieved in 14 of 39 (47%) patients, and residual tumors smaller than 2 cm remained in 12 (40%) patients. In 19 (63%) patients, intestinal resections were necessary. Operation time, blood units needed, hospital stay, and complication rates were comparable to those associated with primary debulking procedures. Results. Survival time after second operation was closely correlated with the residual tumor remaining after second surgical procedure and also with the length of the recurrence‐free interval. Patients with complete resections had significantly longer survival times than those with residual tumors of less than 2 cm (median, 29 months versus 9 months; P = 0.004). Patients with a recurrence‐free interval of more than 12 months had a longer survival time than those with a shorter disease‐free time (median, 29 months versus 8 months; P = 0.002). Postoperative treatment also was shown to influence survival time, whereas grade of the tumor (P = 0.74), age of the patient (P = 0.87), and initial FIGO stage (P = 0.58) had no influence on survival time after second operation. Multivariate analysis (Cox regression) revealed that residual tumor after second surgical procedure (relative risk, 4.7) was the most important independent variable predicting survival time after second surgical procedure. Recurrence‐free interval (relative risk, 2.7) and postoperative (second‐line) treatment (relative risk, 3.0) were equally potent variables. Residual tumor after primary operation, was almost significant (P = 0.06) in the univariate analysis, but was canceled in the multivariate setting by the recurrence‐free interval. Again, FIGO stage, grade of the tumor, and patient age had no predictive value. Conclusions. The authors conclude that radical surgical procedure can prolong survival times in patients with recurrent ovarian cancer. Patients who had a complete resection of cancer tissue in the primary operation or those who experienced a disease‐free interval of more than 12 months after primary operation are most likely to benefit from second operation in recurrent ovarian cancer. Radical surgical procedure should be offered to these patients to enhance efficacy of second‐line chemotherapy, which is of limited value in bulky recurrent disease.

Objective: To investigate the clinical usefulness of the dichotic single-frequency auditory steady-state response (ASSR) for estimation of behavioral thresholds in children with severe to profound congenital sensorineural hearing loss. Design: A comparative experimental research design was selected to compare behavioral and ASSR thresholds for the sample. Behavioral pure-tone audiometry served as the criterion standard.

Conclusion. High frequency immittance measurements demonstrate promise in clarifying middle ear status for neonates but age-and gender-specific norms should be consulted. Objective. To describe high frequency immittance measurements using a 1000 Hz probe tone for a sample of 278 neonatal ears (0-4 weeks of age) in order to compile normative tympanometric and acoustic reflex criteria. Subjects and methods. Assessment of neonatal ears included 1000 Hz probe tone immittance measurements (tympanograms and ipsilateral acoustic reflexes), and distortion product oto-acoustic emission (DPOAE) screening. Results were compared and normative values were compiled for immittance measures in ears controlled for normal middle ear functioning (n=250). Results. Comparison of immittance results to OAE screening outcome provides estimates of sensitivity and specificity for middle ear fluid with tympanometry of 57% and 95%, and 57% and 90% for acoustic reflex presence, and 58% and 87% for combined tympanogram and acoustic reflex results, respectively. Normative data indicate that static peak admittance values differ significantly across gender and age with the 5th percentile cut-off value for the entire sample at 1.4 mmho. The 90% range of tympanic peak pressure normative values increases with increasing age from 140 daPa for neonates 1 week of age to 210 daPa for neonates 2-4 weeks of age. Acoustic reflexes were elicited at 93±9 dB with a 90% normality range of 80-105 dB.

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This paper presents preliminary results obtained with the use of the auditory steady-state response (ASSR) technique as part of a cochlear implant candidacy assessment protocol for infants Fifteen infants (30 ears), between 10 and 60 months of age, with severe-to-profound hearing loss participated in the study. ASSR measurements were performed for 0.5, 1, 2 and 4kHz at intensities up to 120-128dB HL. The ASSR thresholds were obtained in 74%, of the measurements, and exceeded the maximum auditory brainstem response (ABR) intensity output in 91% of cases and the maximum free-field behavioral intensity output in 84% of cases. Eighty-seven per cent of ASSR threshold measurements were measured at intensities of 100dB HL or higher, and almost half (47%) were measured at intensities of 115 dB HL and higher. Preliminary results indicate that absent ABR and behavioral thresholds do not preclude the possibility of residual hearing, making the ASSR a primary source of information regarding profound levels of hearing loss.

Newborn hearing screening is the procedure of choice for ensuring optimal outcomes for infants with hearing loss, whether in a developed or developing country. Unfortunately, apart from a small number of recent exceptions, newborn hearing screening has been a practice reserved for the developed world. Despite the prevailing challenges towards implementing hearing screening in developing countries, there are existing structures in these countries that need to be investigated as possible platforms from which programs can be actualized. Immunization clinics, constituting part of a primary healthcare approach characteristic of developing countries, offer one such a platform. A novel service delivery model, based on initial results from a pilot study, was developed for infant hearing screening at immunization clinics in South Africa as an integrated part of primary, secondary, and tertiary levels of healthcare. This type of model is a first step toward ensuring that infants with hearing loss in developing communities are afforded opportunities for optimal development and societal integration through accountable and contextually relevant early hearing detection and intervention services.

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