The forms, causes, and treatment of tinnitus aurium / by W. Douglas Hemming.

  • Hemming, William Douglas, 1848-1881.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: The forms, causes, and treatment of tinnitus aurium / by W. Douglas Hemming. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    4/8 (page 4)
    The above are the principal forms in which we find the symptom showing itself. In considering a little more in detail the causes of them, it will be convenient to divide them into two great classes, extra-aural and intra-aura], and to subdivide the latter class again, in accordance with the three divisions of the organ of hearing. The extra-aural causes of tinnitus may depend upon a derangement of some part of the body in the immediate vicinity of the ear, or may be due to a morbid state of the system generally. Causes situated in the immediate vicinity of the auditory apparatus are such as narrowing of a vessel, for example, a branch of the temporal, of the posterior auricular, or of the carotid artery. The position of this last-named vessel renders any abnormality in the circulation of blood through it especially likely to produce aural symptoms. The cause in other cases will be more remote, and may be found in an aneurism of a branch of the aorta or of that vessel itself. Of general constitutional causes, anaemia is a very common one, the well know bruit de diable propagated from the vessels of the neck caus- ing sounds which in this case, as well as in aneurism, are of a pulsating character. Other general causes are numerous; bathing, mental ex- citement, overwork of the brain, depression of spirits, hysteria, hypo- chondriasis, gout, dyspepsia, obstructed portal circulation, exposure to blasts of cold air, the effect of explosions or of artillery practice, have all been mentioned by authors as causes of the symptom. The effect of quinine in producing tinnitus is also well known. Childbearing and lactation are frequently accompanied by trouble- some tinnitus, which is also common about the menopause. It is probable that, in these cases, the actual cause is found in the anaemic condition of the vascular system in the former cases, and the generally disturbed state of the nervous system in the last. Tobacco, whether smoked, chewed, or snuffed, is a more frequent excitant of tinnitus than is supposed. The sound produced is of a “sea-shell” character; and, according to Dr. Ladreit de Lacharriere, it is the result of changes in the Eustachian tube, being more intense according as the obstruction of the tube is more complete. It is accom- panied by deafness. Tinnitus may or may not accompany the deafness frequently produced by the diseases of infantile life, mumps, whooping-cough, and the ex- anthemata, especially scarlatina. Cerebral disease frequently accompanies, if it do not cause, tinnitus; but in the case of insane patients it is necessary to differentiate from tinnitus the hallucinations of hearing of which they are so often the victims. Intra-aural causes, as I have said, may be subdivided according to the three divisions of the organ of hearing. 1. External Ear.—The conditions of this part causing tinnitus are: (a) Inflammation of the external meatus; (b) Impacted cerumen; (c) Deficiency of cerumen; (d) Hairs in the meatus or lying on the mem- brane; (e) Dried pus pressing on the membrane; (f) Aspergillus in the meatus; (g) Any other foreign body in the canal which presses on the membrane. Detailed consideration of these conditions is unneces- sary, as they are all discernible by means of the aural speculum. 2. Middle Ear.—The following conditions of the middle ear cause tinnitus: (a) Adhesive mucus on the inner surface of the membrane, in the tympanic cavity, or at or near the orifice of the Eustachian tube, due to middle ear or postnasal catarrh; the tinnitus is of a bubbling