1883 Journal of the American Medical Association  
of which an abstract follows; The study of the ear symptoms in nervous diseases has not kept pace with the general advance in neurology during the past twenty years, although otological research itself occupies at present a front rank in scientific progress. It is not to be expected that the general practitioner should gain a thorough knowledge of the ear, al t hough it is unfortunate that he should neglect it al t oget her , as in the exanthemata, where a little knowledge of otology would
more » ... otology would sometimes prevent, for exampl e, hyper\l=ae\mia from becoming a purulent inflammation, causing not only deafness but more serious symptoms, by extension of the process. There is certainly no reason for leaving the ear entirely out of consideration in the diagnosis and scientific study of nervous diseases. The eye has been so carefully studied for some time among neurologists that the di¬ agnosis of locomotor ataxia or cerebral tumor without ophthalmoscopic examination is the exception, and the symptom " blindness " without further explana¬ tion would be considered an absurdity. Although we can not assume that an equal amount of advan¬ tage is to be expected from the study of the ear, there is certainly much to be gained, and it should not be altogether neglected. As an example of the practical value of adding otological to neurological study may be mentioned the recent investigations into hysterical deafness, which have shown that it has pathognomonic charac¬ teristics, the hearing through the bone disappearing first, then that for high tones. A knowledge of these characteristics is not only of value in diagnosticating the simple hysteria, but also medico-legally in exam¬ ining the hysterical symptoms following railway and other injury, as recently pointed out especially by Dr. J. S. Putnam 2 and the reader. A case, has, however, been recently reported by 3 Landau and Remak, in which left sided hemiaesthesia of hysteri¬ cal origin was accompanied by deafness on the oppo¬ site side. No examination of the ear was made and the hearing was only tested by the watch, and that only in the air, so that the right sided deafness may as well be attributed to middle ear disease, for ex¬ ample, as to hysteria, though no conclusions at all can be drawn from such incomplete evidence. A systematic review of published cases in German, French, English and American journals show that while the eye is rarely, the ear is generally left out of consideration in diagnosticating cerebral disease. The cases in which the ear is neglected may be classed as follows: (i) Those in which no note what¬ ever is taken of the condition of the hearing, al¬ though the presence or absence of deafness would be of diagnostic value; (2) cases in which deafness is mentioned as a symptom in nervous disease without sufficient examination to exclude disease of the ear itself. The first is by far the most numerous class and includes, perhaps, the large majority of cases of cerebral lesion, such as tumor, haemorrhage and abscess, to say nothing of hysteria and allied dis¬ turbances. Why the auditory nerve should be left out in the otherwise systematic analysis of such cases is not clear. The presence or absence of deafness would be of importance, for example, in question of lesion in the pons or cerebellum. Seymour3 has re¬ cently reported a case of cerebellar tumor pressing on the pons, in which deafness by air and bone added much to the certainty of the diagnosis afterward cor¬ roborated by autopsy. Although this case comes under the second class mentioned in that no exami¬ nation of the ears was made, the probabilities were in favor of the tumor as the aetiological factor, and the case is quoted because Nothnagel in his text book on diagnosis of cerebral diseases states that no case of deafness is on record resulting from cerebellar disease. The same writer states that the auditory nerve is not often affected by tumors and haemorrhages of the pons, basing this opinion on the fact that deafness is rarely mentioned in reports of such cases. He says himself that the fact is remarkable considering the situation of the auditory nerve. The most probable explanation of the seeming rarity of deafness in cases of disease of the cerebellum and pons is that it is sel¬ dom sought for, deafness being a symptom which often eludes the observation of both patient and physician, because fair hearing in one ear usually suffices until special attention is called to the sub¬ ject. (2.) Deafness is frequently mentioned as a symp¬ tom of nervous disease by observers otherwise most accurate, with no examination or only superficial ex¬ amination of the ear, so that the reader is often left in doubt as to whether the deafness is really due to the nervous lesion (tumor, locomotor ataxia, etc.), or to a plug of cerumen or catarrh of the middle ear. In exceptionally careful reports sometimes occurs the statement "membranes normal," but apparently
doi:10.1001/jama.1883.02390180022005 fatcat:yieelwnjrbdibddltmnpw2qxcy