CASE REPORT: A 31-year-old lady with underlying hyperthyroidism, dilated cardiomyopathy with severe mitral regurgitation presented with shortness of breath. She was intubated and admitted due to decreasing Glasgow Coma Score. Her blood investigations revealed increased white cell count, raised free thyroxine with suppressed thyroid stimulating hormone, deranged liver, renal and coagulation profiles. As her condition did not improve with initial treatment, plasmapheresis was commenced on day 4. Biochemically, her thyroid function test (TFT) showed improvement; however, she succumbed due to multi-organ failure.
DISCUSSION: Plasmapheresis is considered in TS if there is no clinical improvement within 24-48 hours of initial treatment. The improvement in patient's TFT post plasmapheresis signifies its role in treating TS. Unfortunately, there was a delay in commencing plasmapheresis due to haemodynamic instability in this patient.
MATERIALS AND METHODS: In this repeated-measures study, 40 Malaysian adults (aged 19-26 years) with normal hearing bilaterally (based on PTA results) were enrolled. They then underwent the SAL test based on the recommended protocol by Jerger and Tillman (1960). The SAL normative data for each ear were obtained by calculating the differences between air conduction (AC) thresholds in quiet and AC thresholds in noise by means of insert earphone, B71 and B81 bone vibrators.
RESULTS: The SAL normative values were comparable between the ears (p > 0.05), and the data were pooled for subsequent analyses (n = 80 ears). Relative to B81 bone transducer, B71 bone vibrator produced statistically higher SAL normative data at all frequencies (p < 0.05). The SAL normative values established by the present study were statistically lower than those of the previous study (that utilised headphones) at most of frequencies tested (p < 0.05).
CONCLUSIONS: The SAL normative data produced by the two bone vibrators were significantly different. The SAL normative values were also affected by the type of earphone used. While conducting the SAL test on Malaysian patients, the information provided by this study can be useful to guide the respective clinicians in choosing the appropriate normative data.