A text-book of the diseases of the ear / by Josef Gruber.

  • Gruber, Josef, 1827-1900.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the diseases of the ear / by Josef Gruber. Source: Wellcome Collection.

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    very much better if it be at the same time accompanied by a loud noise, than if it occurred alone. It is most often experienced by patients when travelling by train or driving in a carriage, under which circumstances they find they hear conversation better than when quiet. The symptom occurs frequently, especially in connection with chronic hyperplastic inflammation in both ears, and has received various expla- nations. The author has been unable to accept any of the theories hitherto advanced, and he imagines that its cause must be referred to different circumstances, partly pathological, partly physiological, which may happen to co-exist in the ear, and bring about a condition favourable to the better conduction of a powerful auditory stimulus. Weber-LieP refers the symptom to the effect of strong and repeated impulses upon the tympanic membrane and ossicles, as a result of which the structures too rigidly fixed by retraction of the tendon of the tensor tympani muscle and thicken- ing of the mucous membrane become somewhat relieved from their over-tension,'' and are thus better accommodated for conduction ; the labyrinthine pressure being at the same time diminished. This view is favoured by the effects of section of the tensor tympani tendon. Urbantschitsch? looks on Hyperacusis Willisii as a physiological symptom. The sensitiveness of the auditory nerve being increased with each stimulation, the ear is capable of appreciating impressions of sound which it would be unable to do if they occurred alone. To the author, neither the view of Weber-Liel nor that of UrbantschitscJi recommends itself. Against Weber-LieV s explanation it may be objected that the symptom occurs in patients in whom the objective conditions cited are absent; and according to the theory of UrbantschitscJi it ought to follow that every patient with impaired hearing ought tobe subject to this anomalous condition ; whereas the proportion of aural patients in whom it is observed is very small. (d) Paracusis loci is applied to a condition described by Politzer and others, which consists in the inability to determine with accuracy the direction of sounds. The symptom occurs in mon-auricular diseases, especially in those of an acute and severe character; but also in affections of both ears, in which they suffer in different degrees of intensity. In accordance with generally accepted physiological views there is nothing remarkable in the phenomenon, and it usually disappears after a short time. 1 Ueber das Wesen und die Heilbarkeit der häufigsten Form progressiver Schwer- hörigkeit. Berlin, 1873, S. 136. 2 Lehrbuch der Ohrenheilkunde, S. 348. \