A Guide to the Study of Ear Disease

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Johnston, 1884 - Ear - 198 pages
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Page 165 - As a considerable proportion of these cases only came under observation after an apoplectic seizure had occurred, it is fair to assume that auditory phenomena occur even oftener. Disturbance of hearing may then, under some circumstances, become an important element in the diagnosis of basilar aneurism.
Page 186 - there is no form in which a gouty affection of the ear is so clearly marked as in a peculiar obstinate irritability of the meatus, attended with slight serous or sticky discharge with itching and pricking pain, the walls being somewhat swollen, with a tendency to purple in their redness. In these cases the membrane also is congested, but the structures of the tympanum may apparently scarcely be involved.
Page 158 - ... foreign body in the meatus is liable to produce the symptom in question. The mass may be large or small, it may be composed of wax, epithelium, fungus, or the products of an eczema. In these cases, I believe the actual cause of tinnitus is to be sought in one or more of the following factors, viz. : — 1. Slight vibrations communicated to the drum membrane by contact with the substance ; 2. Pressure on the drum membrane communicated to the stapes, and producing a change of tension in the labyrinthine...
Page 159 - ... considers that the tinnitus in those cases is produced by reflex spasm of the tensor tympani excited by the foreign matter. I fail, however, to see the necessity for such an hypothesis. It is in middle-ear disease, with imperforate drum membrane, that we most frequently meet with tinnitus aurium. In such cases the symptom is usually ascribed to one or more of the following causes : — 1. Abnormal conditions of the intrinsic muscles of the tympanum ; 2. Vascular changes ; 3. Increased intra-labyrinthine...
Page 158 - Hyperaesthesia means that stimuli are readily conducted by the nerves, and widely diffused in the ganglia ; but it does not imply that the nerves can convey impressions which have no existence. It seems perfectly obvious that tinnitus must arise from a stimulus, either applied to the auditory nerve or conducted by other channels to its centre. Stimulation of the former may be, and under ordinary circumstances always is, due to vibration of the fluid contents of the labyrinth. Occasionally pathological...
Page 169 - ... vessels. Nitrite of amyl, however, which, at least in some persons, produces ringing in the ears, apart from the audible pulsation of the carotids, causes hypersemia of the retina, so much so that vessels invisible before the inhalation become afterwards well marked, as Deutschmann has observed. Again, it is fair to assume that the vessels of the labyrinth share the dilating influence, and that in the action of nitrite of amyl, as well as in the tinnitus of lithsemia, increased calibre of the...
Page 164 - Lebert in his classical papers on intra-cranial aneurism* writes : ' Of the greatest interest are disorders of hearing ; but we cannot always ascertain in what proportion they are due to changes in the auditory nerve itself, or its nucleus, and to what extent the small internal auditory artery — which is for the most part hidden from ordinary observation — by becoming obliterated contributes to the result.
Page 164 - September 1881. in the auditory nerve itself or its nucleus, and to what extent the small internal auditory artery, which is for the most part hidden from ordinary observation, by becoming obliterated, contributes to the result. Tinnitus, impairment of hearing, partial deafness on one side, becoming complete, and at a later stage bilateral, or even bilateral from the beginning, are the symptoms which have been observed. The observations are unfortunately not always complete, ie, deafness and unilateral...
Page 183 - ... seat of inflammatory changes ; whereas, when deafness begins on or after the fourteenth day, the internal ear has become involved by extension of inflammation along the auditory nerve. (4. ) Those who are able to hear high notes have a better chance of recovering hearing than those who cannot.
Page 166 - Richardson 3 described several cases of bruit in the neighbourhood of the ear, in which tinnitus was a prominent symptom, and yet no aneurism existed. In one patient general treatment effected a complete cure. A similar case was described by Mr.

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