HYPEREMIA OF THE INTERNAL EAR. BY W. H. WINSLOW, M.D. Hyperæmia of the internal ear frequently co-exists with tympanic disease and with disorders of circulation in the cerebrum. The amount of blood in the labyrinth is increased beyond the normal; the blood may be in active circulation, coming in and passing out rapidly, or the currents may move slowly, leaving stagnant foci here and there. Both conditions may produce pressure upon the filaments of the auditory nerve, and thus give rise to nearly similar symptoms. The congestion supervenes frequently from slight causes and passes away without doing any more damage than temporarily altering the functions of the apparatus. Again, it remains constant, induces slow or rapid pathological changes in the membranous labyrinth, and causes partial or total deafness. It is the condition antecedent to the grave affections of the internal ear, which occur as a consequence of certain constitutional diseases, and should always be regarded with suspicion. Labyrinthine congestion of a mild grade is produced by acute and chronic diseases of the tympanum. Anastomosis of the vessels of the mucous membrane of the latter and of the internal ear has been demonstrated by the researches of Politzer. Anything that causes hyperemia of the middle ear, such as impacted cerumen, furuncles of the canal, injuries of the drumhead, sore throat, obstruction of the Eustachian tube, etc., will produce corresponding congestion in the deeper structures. On the other hand, hyperemia of the brain from mental states, hysteria, general debility, mental worry and exhaustion, indulgence in alcoholic beverages, large doses of quinine and some other medicines cause congestion in the labyrinth very soon, because of the direct and copious supply of blood to the parts through the internal auditory artery. Graver degrees of labyrinthine congestion, those which often lead to profound organic change, occur from disease of the temporal bone, fracture of the skull, meningitis, apoplexia, cerebral abscess, tumors, aneurisms, obstruction of the venous circulation, heart disease, poisoning by Carbolic acid and various constitutional diseases. The symptoms of uncomplicated and moderate hyperemia of the labyrinth are, at first, exaltation of hearing, a sort of hyperæsthesia of the nerve, and sounds of moderate intensity cause discomfort and annoyance to the patient, especially when he is in a quiet place, or if he tries to go to sleep. A fine ringing tinnitus usually accompanies this state, and vertigo is not very uncommon. The mild cases, if continuous, soon merge into severe ones. When the labyrinth becomes much congested the auditory power declines rapidly, ranging from an inability to hear medium voice to total deafness. The tinnitus then becomes louder; coarser and louder sounds of hissing, rumbling, cracking, etc., are experienced; transient spells of vertigo occur, sometimes becoming so severe as to cause falling, and the patient feels insecure and alarmed. The symptoms are all aggravated by mental excitement and anxiety, by voluntary exercise of the auditory power, and by general systemic fatigue. Toynbee relates a typical case: "I had for a long while a patient under my care who, when perfectly tranquil, could distinctly hear his daughter reading to him at about the distance of a yard, but if his daughter told him anything which excited his interest, he became so thoroughly deaf as not to be able to hear a sound, and would remain so until the excitement vanished, when his hearing would return." I had a young lady under treatment for a mild tinnitus, with unobstructed tubes, and nearly normal tympana. She was inclined to plethora, and had considerable cerebral congestion and nervous disturbance during menstruation. The deafness varied from low to loud voice. In spite of treatment, she grew worse. I found that she was taking a glass of ale at lunch every day. I stopped this, her head became clear, vertigo ceased, the hearing improved much and remained good. Diagnosis. The disorder can be recognized by its history, subjective symptoms, and response to certain tests. The galvanic current will give abnormal formulæ ; the fork, in most cases, will not be heard clearly, and the other parts of the ear will show conditions not potent to cause such great impairment of auditory power. Treatment. The cause of the hyperæmia should first receive attention, and when this consists of morbid conditions of the middle or external ear, or of the brain or interior structures, they should be removed, if possible, by treatment of the ear and general constitutional remedies. The general health and strength should be raised to the highest degree by careful regulation of the physical and mental labor, diet, exercise, recreation and personal habits, and by the administration of a little ale or wine. Of the medicines appropriate for ordinary cases Belladonna is very efficient. It diminishes the hyperemia of the labyrinth and brain, often in a surprisingly short time. Cinchona has a specific action upon the auditory apparatus, and is suitable for patients of nervous temperament who have been subjected to mental strain. and worry, and perhaps, exposure to a malarial atmosphere. Kali bromidium relieves congestion, dullness of hearing, tinnitus, and the uncomfortable, strained, confused feeling of the head very promptly. Nux vomica suits passive congestion in spirit drinkers. It stimulates the vaso-motor nerves, causes contraction of the blood vessels, and thus relieves the labyrinthine disorder. Salicylic acid has been recommended in tinnitus dependent upon hyperæmia, and has proved curative in some cases. Conium and Pulsatilla are excellent medicines when a female patient has hyperemia depending upon menstrual disturbance. Bryonia and Colchicum may prove valuable when the affection is connected with rheumatic or gouty manifestations. Kali hydroid. ought to be given when the history or symptoms point to a possible syphilitic lesion. The galvanic current may be tried as a dernier ressort when other measures are unsuccessful, provided there are no cerebral or other contra-indications. The anode should be placed in the auditory canal and only a weak current employed. |