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- Too suspicious about other's talking
- Irritability, distraction etc. as emotional problems
- These types of behavioural problems will suggest that the person is having difficulty in hearing.

Hearing Tests

1. Conversational voice test: Use common words which are familiar to the patient. Keep the patient at a distance of about 20 feet and ask him to repeat the words said to him by the tester. Each ear to be repeated separately
2. Whisper test: Distance of about 3 feet between the tester and the patient
3. Watch tick test
4. Crumbling sounds-using tissue papers etc.
5. Dropping of a coin or metallic piece without the knowledge of the patient
6. Using various pitch pipes-different frequencies low, middle and high tones and other screening sound (if possible calibrated)
7. Tuning fork tests
8. Communicate with the patient as far as possible without showing your face or lips
9. Audiometry if available.

THE LECTURE LASTED FOR AN HOUR. TWO CASES OF TYPICAL OTOSCLEROSIS WERE DEMONSTRATED.

-P. Sadanandam

UROLOGICAL PROBLEMS

The process of ageing brings on with it several changes in the organ systems. The creatinine clearance falls down, as the glomerular filtration rate of the elderly is Iow, and the capacity for tubular reabsorption is low. The excretory function is impaired, due to decreasing expulsive force of the bladder and an enlarging prostate which causes obstruction to the free voiding of urine. The other problem of the elderly is loss of potency.

Examination of the patient with urinary complaints

Micturition problems are elicited using the screening schedule. The complaints often are: (1) increase in frequency especially nocturnal polyuria, (2) hesitancy in passing urine where initiation is impaired. The patient may have urgency, tending to wet his clothes as he walks to the toilet, (3) He may pass a large amount of urine, (4) a major complaint is retention of urine. Leading questions must be asked to elicit whether or not the patient has haematuria, a history of drug intake especially analgesics. tetracyclines, other chemotherapeutic' agents. Past history of diabetes and/ or hypertension must be enquired for.

During general examination one must include the presence or absence of pitting oedema feet, puffiness of face, anaemia. Examination of the abdomen should be directed towards, assessing the distention of the bladder. Rectal examination is to be

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