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In the Netherlands, Streptococcus suis is a rare cause of meningitis. Over the past few years, the number of reported cases worldwide has increased. The bacterium is mainly isolated in pigs, but humans can also become infected.At the Emergency Department, a 60-year-old man presented with headache, confusion, fever and nuchal rigidity. He worked at a meat factory. Laboratory testing showed abnormalities linked to bacterial meningitis. S. suis was cultured from blood and cerebrospinal fluid. The patient was treated with dexamethasone, ceftriaxone and later benzylpenicillin intravenously. He recovered well, but had bilateral perceptive hearing loss as a sequela.Particularly people who are in close contact with pigs have an increased risk of S. suis infection. S. suis meningitis can be very severe and lead to serious complications and even death. Rapid diagnosis and adequate treatment are critical. Permanent hearing loss is the most frequent sequela.

A 76-year-old man developed a progressive bilateral hearing loss 4 days after starting a high dose of clarithromycin for atypical pulmonary tuberculosis. When the clarithromycin was discontinued the hearing improved subjectively but it worsened again upon reexposure. Halving the dose resulted in both an objective and subjective improvement in hearing, yet the original level of hearing was only obtained once clarithromycin had been permanently withdrawn. It would seem that this adverse effect is dose dependent. This seems to be the first published case study that demonstrates ototoxicity as a result of clarithromycin use.

To compare the results of hearing tests performed with the Audioscope III and the classical audiometer.Cross-sectional study.Two general practices in South Limburg, the Netherlands.The hearing of 115 patients aged 55-93 years who visited the practice for any reason was tested with the Audioscope III and subsequently with the screening audiometer, in two silent examination rooms. The tests were performed independently by two general practice trainees. Finally, the subjects were asked which instrument they preferred. An ear was diagnosed as 'hard or hearing' if the Fletcher index measured with the audiometer was30 dB or if, with the Audioscope III, 1, 2, 3 or 4 tones were not heard at 40 dB.Depending on the number of tones not heard, the agreement between the measuring results ranged from 65 to 86%. If subjects during the examination with the Audioscope III failed to hearor = 2 tones at 40 dB, the conclusion 'hardness of hearing', judged by the audiometric results, was correct in all cases. Conversely, the proportion of ears incorrectly diagnosed as 'not abnormal' at this limit was 39%. Hearing tests with the Audioscope III took little time (0.5-4 minutes) and were in general tolerated well.The Audioscope III is a useful instrument in situations in which there is a high prevalence of auditory disorders, for instance in general practices with a relatively elderly patient population.

In this paper we present you our clinical experience of 2 cases in which we implanted the Audiant Bone Conductor (by J. Hough). Our conclusion is that we should be very careful in making the decision to do such an implant; indications and limitations should be known by every surgeon who intends to do an implant.