INTERNAL EAR DISEASE.
Inflammation of the labyrinth may he the result of pyogenic infection from middle ear disease, in which case a radical operation upon the lines before mentioned must he promptly undertaken and the labyrinth drained through the vestibule after all necrosed tissue has been removed. Where the disease follows meningitis, simple or cerebrospinal, there is little hope of recovery from the deafness, the only treatment available being large doses of Iodides, with constant blistering over the mastoid.
Deafness which arises in syphilis is usually due to implication of the auditory nerve, and may be of the congenital or acquired kind. The only hope of restoring function lies in the active treatment of the primary disease by .lerctirv, and in those cases where the affection shows itself in the late secondary stage inunctions should he prescribed and pushed till the system has become saturated by the drug. Large doses of Iodides should then by pushed to the limits of toleration; these alone or com bined with Bromides will usually relieve the vertigo and tinnitus which air c.)111MulliV present. l',Iistering over both mastoid regions alternately should be persevered with. and Chentle recommends fortnightly courses of ]'iloc,upine injected Disease of the internal ear may manifest itself by symptoms which are also sometimes enthely due to trouble in the outer or middle ear; hence treatment cannot he undertaken with an) hope of success until the site of the mischief has been determined. This is obvious when we con sider the treatment of the most common svinptorns---vit.: T11717771Is When this is produced by a plug of cerumen in contact with the tympanum tlft removal of the was will afford speedy relief. When the result of pressure in the middle ear it may be due to cholesteatomata or cicatrices causing deformities of the drum or adhesion of the stapes, &c. Al lien due to internal ear disease the mischief may be caused In- inflammatory conditions in the labyrinth or in the terminations of tile auditor nerve, or it may be due to centric causes distmbing the or .affecting organic changes in the nucleus of the nerve or its tray is within the brain. In the majority of these cases all that can i.e accomplished by treatment is to palliate the distress by large doses of 11romides„ which fortunately in most instances afford marked relief when the cause of the tinnitus is beyond the possibility of removal. The tinnitus associated with cicatricial changes in the tympanum, adhesions or oto s/ Icrosis following chronic dry catarrh or suppurative affections of the middle ear may be greatly relieved and in some cases permanently cured by injections of fibrolysin combined with the use of oto-massage. French injects 3o mins. subcutaneously and 5 nuns. are introduced into the middle ear through the Eustachian catheter twice a week for twelve times. The accompanying deafness is adsi improved proportionately, hut the tinnitus may disappear under this treatment even w 11C11 the deafness remains as before and versa. The tinnitus produced by quinine, aspirin and
salicylates does not always disappear upon withdrawal of the drug; this is expo iallY true when deafness remains, as in those who take large doses of quinine for malaria.
'lie tinnitus of arterio-selerosis, valvular lesions, anemia, plethora and other i irculatory disturbances should be met by agents directed against the primary cause. The toxic tinnitus of chronic Bright's disease yields to purgatives and other eliminatory measures, and as already stated the sYmptorn usually accompanies syphilitic disease of the internal ear, and yields to iodides and 11g.
:Iuditory same remarks in the main apply to the treat ment of this common symptom, which is also frequently due to the above uTtust s a( ting in such a way as to produce increased tension in the labyrin thine fluid. The resulting giddiness is often associated with tinnitus and followed by vomiting. The best routine treatment when the primary cause cannot be removed is to purge freely and put the patient upon full doses of Bromides.
Vertigo is the name given to the symptom-complex in which paroxysmal attacks of vertigo, tinnitus and more or less persistent deaf ness are always present. The causes are various and practically identical with those already mentioned as factors in producing tinnitus and vertigo, and hence it is often described simply as aural vertigo. The name was originally applied by Meniere to the vertigo, deafness and tinnitus caused by labyrinthine hxmorrhage, and the term is usually restricted to those cases of internal ear trouble when the triple symptoms are unassociated with otorrhceal discharge. As the most potent factor in the majority of cases is probably an irritative lesion involving the terminations of the vestibular branch of the auditory nerve in the ampulla, the indications for treatment are to reduce the hyperexcitability of these and at the same time to render more stable the equilibrium of the co-ordinating centre in the cerebellum. Both these indications are fulfilled by bringing the patient under the influence of full doses of Bromide of Sodium. In hmmorrhagic cases Pilocarpine hypodermically with blistering over the mastoid may be tried. As the deafness progresses and becomes complete the vertigo tends to lessen and disappear, though the tinnitus may remain.
The treatment of Nervous Deafness—viz., deafness arising from disease of the auditory nerve or its centre apart from ear disease—is practically beyond the reach of medicine, except in the syphilitic cases as already mentioned. Hyperxsthesia of the auditory nerve or Hyperacusis is the opposite condition, and may be functional as in hysteria, when it will yield to Weir Mitchell and other recognised measures; if organic as in cerebral tumour and meningeal affections, when large doses of Iodides fail to give relief, Bromides combined with Antipyrine may be tried advan tageously.