Objectives: To investigate the use of Transient Evoked Otoacoustic Emissions (TEOAE) as a screening tool for hearing in well babies. Subjects and Methods: Three thousand well babies were screened in three stages using TEOAE in the first two days after birth. Results: Out of 3000 infants screened, 94.3% passed the 1st screening. During the 2nd screening, 166 babies out of 170 passed the test. Four infants (0.13%) failed the test. These were found, to have bilateral profound hearing loss by auditory brainstem response at 6 months of age. Conclusion: The use of TEOAE is recommended in universal screening programmes for the new-borns.

Objective: To evaluate our experience in treating cholesteatoma surgically to compare the results with published ones and lo draw conclusions which may improve or modify our surgical technique. Methods: Between 19S5 and 1994, 135 files of patients who underwent mastoidectomy as treatment of cholesteatoma were reviewed . Personal data and radiological, audiologica., surgical technique and follow-up results were captured and analyzed. Follow-up period ranged from 0 to 8 years. Results: TI,ere were 135 patients, 96 males and 39 females with an age range of 2-61. The main symptoms were otor- rhoea, hearing loss, tinnitus and vertigo. Fourteen had mastoid abscesses, three facial pals.es, three dead ears and three positive fistulae. The majority were attic disease with polyp formation. Canal Wall Down Mastoidectomy (CWDM) was performed in 93.6% and Canal Wall Up Mastoidectomy (CWUM) in 6.4%. In the group w.th CWDM 42% had con- chomeatoplasty. 31 soft tissue meatoplasty and 34% with no operative detail. Only 100 ears with CWDM had more than 6 months follow-up. of these 7% had dry cavities and 24 wet cavities. CWUM was performed in 9 ears, of which 5 had Cholesteatoma. Four of these kept discharging; hence they underwent revision surgery in the form of CWDM. Conclusion: Middle ear cholesteatoma in our community is an extensive, destructive and complicated disease. CWDM results usually in dry and safe ears while CWUM is unsafe. Special attention should be given to the facial nerve during surgery. Adequate meatoplasty is very important to achieve dry ears.

Objectives: To examine the clinical data concerning tracheostomy, for assessing its value, against the background of our local hospital experience. Settings: King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia. Patients and Methods: A retrospective study reviewing the case records of 120 patients who had elective tracheostomies in the period from March 1990 to June 1997. The data collected pertaining the age, sex, the diagnosis indicating tracheostomy, complications, the advantages and the disadvantages were analyzed. Results: The male: female ratio was 3:1. The 21- 40 years age group, were 46 (38%) patients and 32 (70% ) patients out of this age group, were victims of road traffic accidents and had severe head injury and polytrauma. Those were followed by 26 (22%) patients in the age group of 0-20 years. The older age groups of 41-60, 61-80 and 8MOO years, were 17 (14%), 25 (21%) and 6 (21%) patients consecutively. Conclusion: In our series, the head injury and polytrauma secondary to road traffic accidents constituted the commonest indication for tracheostomy specially in the young group of males under 40 years age groups. The tracheostomy is valued for the bed occupancy time of the expensive intensive care unit and generally for decreasing the mortality and morbidity rates. The study also recommends introducing bedside percutaneous dilatation tracheostomy.

Acase of retropharyngeal abscess secondary to brucellosis of the cervical spine is reported. The case under study, presented with hoarseness and progressive dysphagia. Such presentation is the first of its kind in our hospital. For establishing the diagnosis, we depended on the serological results of the standard agglutination tests for brucella, radiological evidence of spinal involvement, and the therapeutic response to antimicrobial treatment, since we could not isolate the organism. The adequacy of the treatment was monitored with repeated brucella agglutination tests.