Eye protection for ENT junior doctors.

Bilateral sudden sensor-ineural hearing loss following non-otologic surgery. Hearing loss after general anaesthesia (a case report and review of literature). (1995) A prospective randomized double-bunded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesthesia and Analgesia 80: 682. Author's reply I thank Mr Gordon for his illuminating and interesting commentary on our case. There are a few points in his letter I would like to address. Firstly, the ear has only a limited number of possible responses to insult of any kind, 'muffled hearing loss', 'tinnitus', 'fullness' are common accompaniments of any sudden hearing loss, and cannot be taken as definitive evidence of hydrops, although I do agree they are suggestive. Much of the literature Mr Gordon cites describe hearing changes after loss of CSF, which was not the situation in our reported case with no spinal anaesthesia and no opening of the dura. Thirdly, I have a very difficult time believing that musical hallucinations are an end organ phenomenon, a result of 'hyper irritable inner ear or incipient hydrops'. In my experience with these hallucinations, they are often complex musical arrangements, and many times patients will describe them as a tape recording. In fact, often they are songs from childhood, and at least two musician patients have been able to listen to them accurately enough to transcribe them in musical notation. It is difficult to comprehend how an irritable inner ear could produce music of this rhythmic arrangement. The most important point against a peripheral mechanism is that most of the cases I have encountered of musical hallucinations (four I can remember) have followed total ablation of the inner ear by a translabyrinthine removal of the inner ear, by definition excluding a peripheral mechanism, at least on the operated side. Nevertheless, I do appreciate the insights Dr Gordon brings to this discussion and thank him for sharing his observations. Dear Sir, The importance of eye protection is well recognized in surgical fields (Bell and Clement; 1991, Berridge et al, 1993). Otolaryngology risks contamination in the operating theatre (Hinton et al., 1991) and during ward procedures. Epistaxis is a common problem managed on the ward by junior doctors. Close proximity to a patient with epistaxis who may be sneezing or coughing inevitably results in a wide dispersion of blood. It would be reasonable to expect doctors packing noses to be provided with eye protection …