Caloric testing reference values may vary according to each unit; the the cutoff point is defined based on local studies. Attention to the technique is essential to maximize test sensitivity.

OBJECTIVE:To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. METHODS:The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. RESULTS:Patients were fi ve years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. CONCLUSIONS:Unsuitability of referrals from primary to secondary care in Otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more effi cient if professionals were better qualifi ed in Otolaryngology.

Dynamic flexible nasolaryngoscopy is a proven diagnostic method, regardless of physician experience.

these findings stress the importance of looking at EAEP in cases where there is suspicion of demyelinating disease and in patients with a defined diagnosis for MS.

Cal oric testing is an otoneurologic evaluation of the status of the vestibular-ocular reflex; it allows an evaluation of each labyrinth separately. The main aspects on the use and interpretation of caloric testing are reviewed. Method: A systematic review of papers published in the past one hundred years on caloric testing was undertaken. The inclusion criteria were: cross-sectional, longitudinal, original articles, reviews and meta-analyses. Reviews of patient charts, case reports and editorials were excluded. The key-words were: caloric testing, nystagmus, vestibular system, directional preponderance, labyrinth predominance, monothermal caloric test, ice water caloric testing, Bell´s phenomenon. The databases were: COCHRAINE, MEDLINE, LILACS, CAPES. Results: Ninety-three of 818 abstracts fulfilled the inclusion criteria. After reading these articles, 55 were selected for this study. These papers discussed the basics of caloric testing, the types of stimulation, the interpretation of results, variables, artifacts, and the monothermal and ice water caloric test. Final comments: Caloric testing reference values may vary according to each unit; the the cutoff point is defined based on local studies. Attention to the technique is essential to maximize test sensitivity.

Al terations in early auditory evoked potentials (EAEP) in individuals with demyelinating disease are suggestive of lesions in the brainstem. Aim: this study aims to evaluate the prevalence of hearing disorders and altered EAEP in multiple sclerosis (MS) patients. Materials and method: sixteen female and nine male patients with a defined diagnosis of multiple sclerosis took part in this study. All individuals underwent hearing and EAEP tests. The wave forms were categorized according to Jerger (1986). Results: fifty EAEP tests were carried out; 70% were classified as type I (normal response) according to Jerger's criteria. Altered EAEP results in at least one ear were classified into types II, III, IV or V according to Jerger. Females accounted for 31.25% of alterations, and males 44.44%, adding up to 36% of all cases. Conclusions: these findings stress the importance of looking at EAEP in cases where there is suspicion of demyelinating disease and in patients with a defined diagnosis for MS.

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Laryngomal acia is the most common cause of stridor in infancy. Diagnosis is established by associating the clinical manifestations with laryngoscopic findings in a dynamic form. Aim: To analyze diagnostic accuracy of laryngomalacia through flexible nasolaryngoscopy performed by four different examiners. Form of studying: Comparison of diagnostic tests (clinical study). Material and method: A protocol of videolaryngoscopic evaluation for patients with laryngomalacia was created encompassing the following items: anterior displacement of the arytenoids; omega-shaped epiglottis; short aryepiglottic folds; posterior displacement of epiglottis; vocal folds being visible or not; edema of the posterior larynx. Four different examiners analyzed the videolaryngoscopic examinations of 18 patients with established diagnosis of laryngomalacia previously established by clinical data, epidemiology and anatomical traits. The four observers knew previously that the patients had laryngomalacia and which criteria should be analyzed in the evaluation protocol. Observers were unaware of the results each one found. Results: diagnostic agreement average considering all parameters evaluated was of 88.2%. Discussion/Conclusion: Dynamic flexible nasolaryngoscopy is a proven diagnostic method, regardless of physician experience.