A patient reported hearing loss in the right ear three weeks ago. She experiences slight tinnitus but no pain or discharge. Since her right ear became deaf, she has noticed an unpleasant vibration like an echo after singing a high note or hearing another do so. After removing impacted wax and inflating ears, the echo disappeared on the same day and did not return two months later.
It is hardly necessary to more than allude to the symptom of tinnitus aurium in primary disease of the labyrinth. It scarcely differs from the sounds heard by those who suffer from INFLAMMATION OF LABYRINTII. 493 chronic non-suppurative inflammation, although in many cases of total deafness no tinnitus exists, and, so far as my observation extends, tinnitus auriiim is more frequent and disturbing in chronic disease of the middle ear, than in chronic affections of the labyrinth.
Pain is not usually a symptom of disease of the nerve, except in the form which Voltolini calls inflammation of the membranous labyrinth. In these cases it may exist. Acute affections of the acoustic nerve are, however, often accompanied by extreme sensitiveness of the ear to loud, jarring, discordant, or even ordinary sounds. It is then necessary to keep the patient in a very quiet place. I have in one case been compelled to order the patient away from the city to the quiet of the country.
Nausea, vomiting, and convulsions, as well as opisthotonos and delirium, may be symptoms of labyrinth-disease, as well as of cerebro-spinal meningitis and of acute catarrh of the middle ear. The symptoms of inflammation of the membranous labyrinth that has been mistaken for cerebro-spinal meningitis should be carefully considered in order that the practitioner may be able to clear up the doubts which have been thrown upon the existence of this disease.
<Callout type="important" title="Critical Symptoms">Deafness, vertigo, nausea and vomiting, loss of equilibrium, inability to hear tuning-fork more distinctly even when ear is plugged, and abnormal sensitiveness to sounds are key symptoms of labyrinth diseases.</Callout>
Electricity has been much used in the study of disease of the auditory nerve. Some authorities believe that we have a positive means of diagnosis in the employment of the galvanic current. With the assistance of my friend, Dr. Eoger S. Tracy, I have carefully gone over the literature of this subject, with a view to the determination of the importance of this agent in the diagnosis and treatment of affections of the nerve.
In recapitulation, it may be said that the chief symptoms of labyrinth disease are — 1. Deafness, usually nearly absolute, and occurring suddenly. 2. Vertigo. 3. Nausea and vomiting. 4. Loss of equilibrium. 5. Inability to hear the tuning-fork more distinctly in the affected ear, even when the ear is plugged. 6. Abnormal sensitiveness to sounds.
Key Takeaways
- Deafness and vertigo are primary symptoms of labyrinth diseases.
- Nausea, vomiting, and convulsions can indicate severe cases requiring immediate attention.
- Electricity has been used in diagnosing auditory nerve conditions but its efficacy is debated.
Practical Tips
- Keep the patient in a quiet environment to reduce sensitivity to sounds.
- Carefully observe symptoms like opisthotonos and delirium, which may indicate cerebro-spinal meningitis or labyrinth disease.
- Use tuning-fork tests to assess hearing impairment accurately.
Warnings & Risks
- Do not ignore sudden deafness accompanied by vertigo as it can be a sign of severe labyrinth inflammation.
- Be cautious when using electricity for diagnosis, as its effectiveness is still under debate and may vary among patients.
Modern Application
While the chapter's diagnostic methods are outdated, understanding historical symptoms remains crucial. Modern technology like MRI scans offer clearer diagnoses but knowing classic symptoms helps in early detection and treatment.
Frequently Asked Questions
Q: What are the key symptoms of labyrinth disease?
The key symptoms include sudden deafness, vertigo, nausea and vomiting, loss of equilibrium, inability to hear tuning-fork sounds distinctly even when the ear is plugged, and abnormal sensitiveness to sounds.
Q: Why might a patient with labyrinth disease need to be relocated?
A patient may need to be relocated to a quiet place if they are extremely sensitive to loud or jarring sounds due to acute affections of the acoustic nerve.
Q: What is the role of electricity in diagnosing auditory nerve conditions?
Electricity, particularly the galvanic current, has been used for diagnosis but its effectiveness and reliability are debated among medical practitioners.