ABSTRACTS

of acute otitis media or upper respiratory infection. All un- derwent commercial air flights and were examined by an otolaryngologist before and after flight. None experienced pain or exacerbation of prior otologic symptoms in an in- volved ear during or after flight. The middle ear space did- not undergo changes in pressure during ascent and descent because the eustachian tube was functionally closed at the time. Because the middle ear is a fluid-containing space, it does not function under the physical laws for gas-filled spaces. Two patients did develop baratotis in a contralateral "normal" ear. These "normal" ears probably had borderline eustachian tube function that predisposed the patient to de- veloping barotitis. It was concluded that the presence of otitis media with effusion precludes the development of barotitis.

Jeffrey Schaider, MD

arrhythmia, ECG

D e t e c t i o n of a r r h y t h m i a s : Use of a pa t ien t - a c t i v a t e d a m b u l a t o r y e l e c t r o c a r d i o g r a m d e v i c e w i t h a so l id -s ta te m e m o r y loop Brown AP, Dawkins KD, Davies JG Br Heart J 58:251-253 Sep 1987

To aid in the identification of cardiac arrhythmias in pa- tients with symptoms of palpitations, syncope, or presyn- cope, these authors studied the effectiveness of a patient-

activated ambulatory electrocardiogram device with a 70- second preactivation and ten-second postactivation memo- ry. one hundred patients (16 to 88 years old; median, 58) with a history of syncope (36 patients), presyncope (38 pa- tients), or palpitations (26 patients) were studied. All pa- tients wore the recorder for three weeks and were instructed to activate the device when they became symptomatic. Six- ty-nine patients had rhythm abnormalities at the time of recorder activation. Twenty of these patients had more sig- nificant arrhythmias, including atrial fibrillation (ten), su- praventricular tachycardia (three), multiform ventricular tachycardia (one), junctional rhythm with a rate of 28 (one), sinus bradycardia with a rate of 25 (one), sinus arrest of two seconds (one), and intermittent atrioventricular dissociation (two). The remainder of abnormal recordings identified less significant arrhythmias, including frequent extrasystoles of one in five or more (12), occasional extrasystoles (27), and sinus tachycardia greater than 120 beats/min (ten). Thirty- one patients had no recorded arrhythmias. In five of the cases of tachyarrhythmias and one case of bradycardia (6% of the study group), the arrhythmia was present only in the pre-event segment of the memory (ie, before the recording was activated by the patient). It was concluded that this re- cording device with a pre-event memory can identify ar- rythmias associated with symptoms that may be missed by conventional 24-hour, continuous monitors or patient-acti- vated recorders without a preactivation memory. Because this device only records symptomatic arrhythmias, the au- thors caution that such a recorder should be used with and not in place of the 24-hour, continuous monitor.

Greg Bennett, MD

168/293 Annals of Emergency Medicine 17:3 March 1988