Manual of diseases of the ear : including those of the nose and throat in relation to the ear : for the use of students and practitioners of medicine / by Thomas Barr and J. Stoddart Barr.
- Barr, Thomas, 1846-1916
- Date:
- 1909
Licence: In copyright
Credit: Manual of diseases of the ear : including those of the nose and throat in relation to the ear : for the use of students and practitioners of medicine / by Thomas Barr and J. Stoddart Barr. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![!•] anti a negative one to a lower, say one of 128 vs.; this is partly explained by the rule that low notes are badly heard by air-conduction in affections of the conducting structures, while higher ones may be well heard. When the higher notes yield a negative result by Rhine’s test there is probably very pronounced disease of the conducting structures. In experiments carried out by the writer, in cases of purulent middle ear disease, he found comparatively few in which, by Weber’s and Binne’s tests, bone-conduction was not in excess. VI. THE ORDER OF EXAMINING A PATIENT. When making an exhaustive examination of a patient suffering from ear disease, the following order and methods are recommended to the student. Preliminary Enquiries. The patient usually mentions at once the symptom or symptoms for which he has come, such as dulness of hearing, noises in the ear, pain in the ear, discharge from the ear, etc. We should then enquire as to: 1st, the duration and course of his symptoms; 2nd, the previous existence of any ear trouble; 3rd, his own opinion of the cause. In regard to the duration and course of the symptoms, we cannot in many cases get definite or reliable information as to the beginning of the trouble, unless it began (1) as an acute inflammation, especially if followed by discharge or dulness of hearing; (2) in connection with a zymotic or other general disease; (3) with a sudden change from good hearing to marked deafness or tinnitus ; or (4) with an injury. More frequently, especially in one-sided deafness, the condition has existed for some time—it may be for years—unnoticed by the patient, till he finds, perhaps quite accidentally, that he does not hear the tick of a watch on one side. In other cases, the occurrence of tinnitus first draws attention to an ear where there has probably been defective hearing for a long time, unknown to the person. Again, in others, the hearing defect, slight at first and slowly progressive, is not observed or admitted by the patient till it becomes so noticeable as to attract attention and compel admission. We should enquire if the beginning has been sudden or gradual, limited to one ear or involving both, and if the course has been steadily progressive or interrupted. Marked variations in the hearing power are of favourable import, as compared with a steady and continuous deafness. Short duration of the symptoms is usually a favourable point, although we often find that the objective condition of the ear points to a much longer duration of the disease than the patient’s account indicates. The previous existence of any ear trouble is important and should be enquired](https://iiif.wellcomecollection.org/image/b24932577_0087.jp2/full/800%2C/0/default.jpg)
