TINNITUS AURIUM.
Buzzing or painful sounds felt in the ear are hut subjective symptoms of some irritation of the acoustic nerve. The treatment of this symptom will obviously depend upon the various exciting causes, and the treat meat of the different diseases of the car, in which tinnitus is a prominent symptom, will he found detailed under Ear Diseases. Under the same heading will he found the details of the treatment of Meniere's vertigo, in which tinnitus is usually an important part of the symptom-complex. Operative procedures have been carried out successfully for the relief of tinnitus, as removal of the mallet's or incur, division of the tensor tympani tendon, trephining the cochlea, and total destruction of the cochlear division of the nerve.
Symptomatic treatment is justifiable when the primary cause is irre movable; Bromides possess a sedative action on the affected nerve which in many cases will cause the disappearance of tinnitus as long as the patient is kept under the influence of the drug. llydrobromic Acid is often recommended, has similar hut much weaker power, and 2o-gr. doses of Sodium Bromide should always be preferred; this amount may be taken three times a day for long periods as in epilepsy. Strychnine is usually combined with the bromide treatment advantageously, but the common mistake is made of giving the alkaloid in full doses, which often increases the tinnitus. Not more than gr. (2 mins. B.P. Liquor) should be given. Iodides in full doses may be tried alone or in combination with bromides. Some authorities advocate the administration of Quinine and Salicylates on the similia sinrilibrr.r rurantur theory, since these drugs in full doses pro duce tinnitus, hut the result is as a rule most unsatisfactory.
Pilocarpine hypodermically has been useful in some acute distressing cases, but such an agent can only be employed at long intervals. Air containing Chloroform vapour, when injected into the Eustachian tube, sometimes gives speedy but temporary relief.
Many patients with incurable internal ear trouble suffering from persistent tinnitus obtain a considerable degree of relief by repeated blisters applied behind the car.
The Ton-behandlung treatment consists in replacing the subjective sounds by real ones produced by a tuning-fork, the objective notes being as far as possible removed in pitch from the subjective sounds.
A strong galvanic or the high-frequency current has given relief in many cases, and some aurists have resorted to lumbar puncture when the tinnitus is due to high blood-pressure.
The mental condition will require attention, as the sounds often suggest brain disease or insanity to the patient, hut even when subjective tunes are heard he may be assured that the trouble is a purely local one.
Such primary and incurable affections as arteriosclerosis and renal diseases when present will require palliatives as Nitro-glycerin or other vaso-dilators and Saline purgatives.
Profound amemia should be treated by Iron or Arsenic or a combination of these drugs, and it should he forgotten that in some cases tinnitus may be a reflex phenomenon due to carious teeth or to nasal trouble. For the former condition extraction is clearly indicated, and for the latter removal of the posterior half of the inferior turbinate or of any outgrowths from the vomer.