CHAPTER XIX. DISEASES OF THE INTERNAL EAR. (Part 8)

which was increased after a second attack of pain. Apparently there is an entire absence of hearing power. There is nothing marked in the appear- ance of the drum-membranes. He totters in his gait. MENINGITIS. SCARLET FEVER. 535 Basilar meningitis, typhoid fever, scarlet fever, measles, and mumps are known to cause disease of the ear. The first-named disease usually affects the internal ear by direct extension of the inflammatory process from the base of the brain. In typhoid fever, however, the primary development, whatever the secondary affection may prove to be, exhibits itself in the middle ear, from " a propagation of the oral and pharyngeal catarrh to the Eustachian tube and cavity of the tympanum."* There may, however, be an extension of meningeal inflamma- tion to the labyrinth. Almost the same may be remarked of scarlatina and measles. It is well known that the affection or- dinarily resulting from the latter named diseases is suppuration of the middle ear. Scarlet Fever— Deafness— No Changes in the Pharynx or the Outer Ear. Jan. 28, 1870, S. M. J., set. 5, had a mild attack of scarlet fever when he ' was eight months old ; the mother discovered that the child was deaf four months afterwards. There would appear to be no hearing power. The tuning-fork causes no sensation. The pharynx and nares are in a healthy state, and the mernbranse tympani show no changes. Convulsions — Deafness. Boy of six years of age. August 13, 1869. Two years ago he had con- vulsions which lasted for two or three days. After he recovered he was found to be deaf, and still continues in that state. Drum-heads sunken on both sides. Appears to be totally deaf. Measles — No Marked Change in Drum-Head— Deafness. Miss P., set. 16, when seven or eight years old had measles, and about six or eight months afterwards became deaf in the right ear. Hearing distance : right 0, left ||. She does not hear the tuning-fork from the right side, but can distinguish the sound of a voice conveyed to the drum-head through a tube. The membranss tympani are normal, except that the light spot is dull. Hydrocephalus — Deafness. Sept. 7, 1870, Carrie X. , set. 4, iu June of this year had, according to the family physician, acute hydrocephalus ■ and when she recovered from it, was found to be deaf, and still continues so. There are no evidences of disease in the membranas tympani or pharynx. *Niemeyer, Hackley and Humphrey's translation, vol. ii., p. 584. 536 MENINGITIS. Meningitis — Gradual Deafness. June 25, 1870, W. K. J., set. 27, complains of increased impairment of hearing-. Had scarlet fever when a child, after which he felt a diminution in the hearing power. Last winter had congestion of the brain and hemiplegia of left side. His right ear became decidedly worse at this time. He has re- covered from the hemiplegia. There is no tinnitus aurium. The hearing distance on the right side 0, left {% Tuning-fork is heard better on right side. The right membrana tympani is sunken, and has no light spot. The left is also sunken, and exhibits two reflections of light. Inflation of the ears improves the hearing on the left side. Basilar Meningitis — Bilateral Deafness. April 30, 1872, William R, set. 27, says that seven weeks ago he could hear well, but after an attack of fever attended by delirium, he found, when restored to consciousness, that he had lost his hearing. There is a roaring noise in the left ear, but no other aural symptom. He can hear the watch when laid upon the right ear, but not at all upon the left. The tuning-fork is also heard more or less distinctly in the right ear. The right drum-head is eomewhat sunken, the left very much so. Meningitis — Inflammation of Cerebral Meninges and Labyrinth— Exposure to Direct Bays of Sun. Sept. 8, 1873, Laura '■, set. 22 months. The mother states that when the child was eight months old, and teething, she was unduly exposed to the di- rect rays of the sun, and was thereupon suddenly attacked with convulsions and was ill for three weeks afterward. The physician in charge observed that she was losing her hearing, and the mother thinks that she has not heard since that period. The drum-heads are both very much sunken and have no light spot. Basilar Meningitis — Effusion about Auditory Nerve — Intermittent Character of Attacks — Epilepsy — Deafness — Becovery. Jan. 29, 1874, Moses B., set. 29, merchant, previous to July last heard perfectly well. He has had intermittent fever at different times for two years ; had also an attack of sunstroke. In July he lost the hearing in one ear, and for four weeks he was deaf with both ears. After a course of coun- ter-irritation his hearing gradually returned. He has taken a large quantity of quinia. Some weeks ago, while at Petersburg, Va., his hearing power again failed, and at the present time he cannot hear words at all ; even the ticking of the watch is not perceived. He cannot hear the tuning-fork when placed upon the head, but feels it when on the teeth. The drum-heads are somewhat opaque, and there is granular pharyngitis. He complains of a se- vere pain in the top of his head, and of a knocking sound in the interior. His countenance is very anxious, appetite poor, but he walks well. There is no history of syphilis. He had a severe fall upon his head, striking the occipital region, when he was seven years of age. 1 saw the patient first at my clinique MENINGITIS. CASES. 537 at the University Medical College, and the next day at my office in consulta- tion with his family physician. I advised iodide of potassium, but I did not see him again for two months, when, at the instance of Dr. Win. A. Ham- mond, he called upon me, and to my great delight 1 found that he could now hear conversation with ease, and the watch at twenty inches ; hearing dis- tance ;'« on each side. He had been under Dr. Hammond's care for about four weeks. Dr. Hammond treated the case by means of the iodide of potassium mixed with the bromide. This treatment relieved the cephalalgia and epilepsy. Subsequently he administered arsenic in consequence of the intermittent type of the epilepsy. The hearing power was suddenly restored on one side, and the other soon became better also. Through the kind courtesy of Dr. II. G. Miller, of Provi- dence, I have been furnished with the following interesting his- tory, and I was also afforded the opportunity of seeing the case : Meningitis — Inflammation of Both Auditory Nerves — Recovery of One. December 29, 1873, H. S., a student of Trinity College, early in Octo- ber had an acute affection of the cerebral meninges and of internal ear, leav- ing him totally deaf in one ear, and nearly so in the other. I saw him first about ten days after the commencement of the trouble. His condition then was : External and middle ears perfectly normal ; subjective noises very troublesome, and extreme giddiness on walking, and especially on attempting to go down-stairs, and also on turning the head in either direction. Hearing distance : right ear, contact for a watch of 30' ; left ear, 0. Timing-fork heard by conduction in right ; not at all in left. I put him on bromide and iodide of potassium, and soon began the use of the constant current. The right ear improved rapidly, and in about five weeks hearing distance became normal. For some time after that, however, through the two octaves of the piano, from middle C upwards, he heard, in addition to the note struck, an- other less than a semitone above, which produced a most disagreeable clang, and rendered music very unpleasant to him. I then saw Dr. Blake in consul- tation, about the left ear. We fouud in it perception for higher sounds than normal, and that this perception was prolonged by the continued current ; and advised the continuance of the electricity, and also the use of valerianate of zinc and conium. Since that time there has been but little change. He has at times heard the watch faintly, but cannot always be sure of it. The auricle of the affected ear was quite numb. No further treatment was ad- vised. Scarlatina — Measles — Mumps — Deafness. September 15, 1S73, H. N. G., set. 34, when two or three years old, is said to have had scarlet fever, and again at eleven years of age. He also had 53S MENINGITIS. CASES. the measles and mumps in that same year. He never had any discharge from his ears, and but rarely any tinnitus. He did not hear the watch at all on the , right side, and thought he heard it slightly when pressed on the left, but was not certain. The tuning-fork is heard more distinctly on the left side. The right drum-head is sunken, but the left one is normal. Air enters both tym- panic cavities without difficulty. Meningitis — Deafness — Normal Membranes Tympani. Sallie A., set. 13, three months ago was attacked with severe headache and vomiting ; delirium at times, but generally consciousness retained. In three weeks the fever subsided. There was no paralysis. She did not hear well after being ill a few days. Was attacked on Saturday, and on Wednesday it was observed that she did not hear words, even when spoken very close to her. The patient complained then, as now, of severe tinnitus aurium ; does not hear the watch at all. The tuning-fork is heard well and naturally. Jar- ring sounds hurt her head. There are no marked changes on the membrana tympani. Stupor — Deafness — Use of Quinia. Gertrude S. , a?t. 27 months, five months ago passed suddenly into a state of stupor. Was very pale, and each day had severe fever. The treatment consisted chiefly, according to the statement of the mother, in the adminis- tration of quinia. The little patient does not seem to have any hearing power. The drum-heads look well ; both have good light spots. Exposure to Draft of Air— Loss of Sensation on one Side of Face— Deafness. July 11, 1870, A. D. B., ast. 58, taxidermist, two years ago, while riding in a railroad carriage, fell asleep, while a window was open near his head, and when he awoke he found that his face was numb, and he was deaf. This deafness continues. There is some impairment of hearing on the other side from a chronic ear trouble, but the tuning-fork is heard only on that side. The patient has been a great sportsman, and has often been temporarily deaf from severe concussion. The watch is not heard at all on the right side, and & on left. Nervous Deafness, perhaps Secondary to Tympanic, Catarrh. Miss O. had the measles when a small child, which left her hearing some- what impaired. What hearing power remained was lost in one night some months ago. She cannot hear the watch, tuning-fork, or speech— in fact, she is totally deaf. The drum-heads are sunken ; the pharynx is in a catarrhal condition. She has been thoroughly treated by a competent physician, but without effect. Convulsions— Pain in Ears— Deafness— Normal Membranes Tympani. Z. A. H, a?t. 6, when eight months old, had spasms until the age of 13 months, sometimes having 15 or 20 fits a day. After the convulsions SPINAL DISEASE. MUMPS. 539 had continued for four or five days, he was discovered to be deaf. The mother is certain he could hear well before this time. During his illness he would at times put his hands to his ears. The recollection of the mother is not distinct as to whether there was any gathering in the ears, but she is in- clined to think there was. The child seems to have no hearing power. Both niembrame tympani are normal in color and position. The tonsils are large. SPINAL DISEASE. Disease of the spinal cord or medulla is sometimes accom- panied by loss of hearing. I suppose the lesion in these cases is one of the acoustic nerve at its origin and along its trunk. The following case is one in point : Failure of Memory — Epileptiform Convulsions — Incontinence of Urine — Great Impairment of Hearing. S. G., set. 40, farmer, March, 1878. Patient states that he has grown deaf for the past two years. He can now only hear words spoken very distinctly and in a loud tone directly into the right ear. He has had a few epileptiform seizures. There is nocturnal incontinence of urine and great failure of mem- ory. He has used tobacco and spirits to excess. When his eyes are shut he cannot stand on either foot without staggering. The drum-head and pharynx exhibit the ordinary appearances from catarrhal inflammation of the middle ear. There is not the slightest improvement to the hearing from inflation of the middle ears. Patient denies ever having had any venereal disease. The patient was referred to an authority on diseases of the nervous system. MUMPS. Parotitis sometimes, fortunately in very rare cases, leaves the patient profoundly deaf. This deafness may be from a direct extension of the inflammatory process from the gland into the auditory canal, tympanic cavity, and nerve, or we may suppose that a metastatic inflammation of the membranous labyrinth has occurred. Tojnbee in his catalogue alludes to hemorrhage into the labyrinth, after the action of the poison of mumps. I have seen but one case where it was plain that nerve-deafness resulted from parotitis. In this case the loss of hearing occurred without pain, and affected both ears. Pro- fessor Henry D. Noyes lately showed a case at the New York 540 ANEUKISM. TUMOKS. Ophthalmological Society occurring in an adult, where loss of hearing, accompanied by inability to walk without staggering, when the eyes were closed, occurred and persisted after mumps. In this case there was metastatic orchitis on the same side with the deafness. ANEURISM— TUMORS. Aneurism of the basilar artery, cerebral tumors, and, in fact, all varieties of intracranial disease, may cause tinnitus aurium and impairment of hearing; but all such cases require special study, and hardly demand a detailed notice. Griessinger says that the symptoms of disease of the nerve, or its expansion, arising from aneurism, are : Difficulty in swallowing ; occa- sionally spasmodic deglutition ; impairment of hearing, or even complete deafness, often appearing at intervals, with great tin- nitus ; difficulty of respiration and articulation ; interference with the excretion of urine, without any impairment of the intellectual functions ; and, finally, paraplegia. Von Troltsch states that a constant sensation of knocking, in the back of the head, is also a suspicious symptom. Dr. Ilughlings Jackson believes that deafness (excluding cases manifestly due to disease of the apparatus of hearing) is a rare complication of intracranial disease. It is very much less common than optic neuritis. Dr. Jackson has not yet seen an autopsy which showed that deafness had depended upon adventitious products, nor upon " any sort of disease of either cerebral hemisphere." One case * is recorded, however, which Dr. Jackson quotes, of tumor of the left cerebral hemisphere, where there has been deafness of both ears. Dr. Jackson thinks that deafness does not result from intercranial tumor, or other adventitious product, unless the auditory nerve is actually involved or pressed upon. According to Sehwartzef, it has been estimated by Calmeil that impairment of hearing occurs in about one-ninth of all cases of cerebral tumors. Aural symptoms occurred, in 77 cases * Royal London Ophthalmic Hospital Reports, vol. iv., part iv., p 420. f Handtauch der pathologischen Anatomie. By E. Klebs. Gehororgan. By Schwartze. TUMORS. TATIIOLOGY. 541 of tumors of the cerebellum, 7 times ; in 26 cases of tumors of the pons, 7 times; in 27 cases of tumors of the middle lobe, 3 times ; but not once in 27 tumors of the anterior lobe, nor in 14 cases of the posterior lobe, and 4 of the fourth ven- tricle. Deafness of one side, according to Cruveilhier, quoted by Schwartze, was one of the first symptoms in a number of cases of central tumors. Schwartze further says, that impairment of hearing on both sides not unfrequently occurs in tumors of the cerebellum, and when from the situation of the tumor, we know that it does not press directly upon the nerve-trunk of the opposite side, nor upon its origin in the medulla, and when there are no symptoms of paralysis of other cerebral or spinal nerves, Schwartze thinks that there may be a neuritis or oedema in these cases. Pathology. — In passing over the subject of the causes of dis ease of the internal ear, we have alluded to the pathology of the affection ; but it may be well to tabulate the post-mortem ap- pearances that have been found in the labyrinth. Inasmuch as very few of these appearances have been accompanied by the history of the case, they have not the importance that they would otherwise have had. Yet they may be of service as a basis for future investigation. Absence of auditory nerve, ....... 1 Atrophy of auditory nerve, . . . . . . .10 Suppuration, 1 Tumor upon, 1 Hemorrhage upon, 2 Thickened membranous labyrinth, . . . . .11 Atrophy of membranous labyrinth, 22 Congestion, 1 Suppuration of membranous labyrinth, .... 3 Serum in labyrinth, ........ 3 Opaque fluid in labyrinth 3 Black pigment-cells too abundant, . . . . . 5 Distention of blood-vessels of cochlea, .... 3 Fluid, opaque, 4 Pus in cochlea, . . 1 Thickened lamina spiralis, 1 Osseous wall of semicircular canals incomplete, .