The symptom-complex of the acute posterior poliomyelitis of the geniculate, auditory, glossopharyngeal and pneumogastric ganglia / J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1910
Catalogue details

Licence: In copyright

Credit: The symptom-complex of the acute posterior poliomyelitis of the geniculate, auditory, glossopharyngeal and pneumogastric ganglia / J. Ramsay Hunt. 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.

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    witli reactions of degeneration; liypestliesia of the riglit side of the face; con- junctival retlex present. Palate innervation, normal. Tear secretion present on both sides. Otologic examination hy Dr. W. S. Bryant, as follows: Bight anricle slightly more ])rominent than the loft. Edematons and tender, especially ahont the concha. Some thin crusts on the lloor of the concha and antitragiis. Canal mnch smaller than on the other side. Enndns of canal bright red, swollen and leaking bloody serum. The niemhi-ana tymphani; anterior half clear, posterior half involved in swelling of canal. Liimen of inner end of canal reduced to one-third of the size of its fellow. Slight tenderness half an inch behind mastoid antnnn. Left ear shows advanced chronic middle-ear catarrh with retraction and contraction of the dnnn membrane and some thickening. Light rellex nearly absent, 'tinnitus in right ear only. ]«'nnctional tests: High tone limit, right ear, 12,500 vih.; left ear, lO.liOO vih. Low tone limit a])i>ears to he the same i;i both ears, between 07 and 5!) vibrations. Fork. 512 single vihiations. was referred from all ])arts of the head to the right ear. Fork 512 vibrations: on the right mastoid 8/30 seconds; on left mastoid 5'30 seconds. Watch: right ear was 4/30; left ear was 11/30. Val- salva’s inllation and politzerization, negative in both ears. Catheterization showed a clear tube and free tympanic cavity on the right. iSnmniarizing, it can he said that chronic middle-ear catarrh and senile changes of both ears are marked, 'riicre is no indication that the two middle or inner ears dill'er very mnch in their condition, 'the sound condneting mechanisms of (he membrane and canal aie all'ected on the right; with myringitis and otitis extenia dilfnsa. On A]iril 3, 1008, there was jiersistent weakness of the right facial innervation with secondary conti'aclnres; hearing nonnal; no ])ain. Ca.se 0.—IJerjtes Oliciis wilk Facial Falsi/.— (Observation by Dr. Sidney I. Schwab of St. Lonis.) ^fiss D., :iged 28. A previous history of old ear tronhle of many years’ duration on both sides. Ihitient was in her usual health np to Apidl 28, I!)()9, when she awoke in the morning with jiain in the right ear and mastoid region, 'this ])ain was accompanied hy headache and some general weakness. I’ains in the ear continued and were very severe. Examination on May 2 revealed a herjietic ernj)tion in the external auditory catial, and on the concha, 'there was also a right facial i>alsy. Pain sense on the jight side of face was diminished in the trigeminal distrilmtion. (1 lypalgesia.) Otological rejJort as follows: Both ears: Bone condnetion decidedly better than air condnetion. (Only C4 heard better hy air condnetion.) Length of time tuning-fork heard hy air decidedly decreased. Ijone only slightly decreased. Fork I)laeed on median line of head always lateralized to liglit side. Left ear: Old kidney-shaped jierforation in drum below handle of hammer which was jiartly destroyed. Speech li.O meters, whisper 0.5 meter. After i)ol- itzerization, si)eech —6.0 m. whisjier more than 0.75 meter. Bight car: 6-8 small ulcers in ditl'erent stages of resolution seen on the anricle, chiefly on the crest of the aniihelix, althongh there were a couple in the concha. 'J'he meatal walls w’cre slightly redder than normal, 'the drnm showed an old cicatrix, occupying the anterioi- inferior (jTiadrant and ]>art of the j)osterior inferior. 'Ihe remainder of the drnm was diffusely reddejied, excej)t for a small red s])ot over the handle of the hammer just below the short ]irocess. 'I'he drum was. as a wdiole. retracted, the handle being almost horizontal. Tfeariiig, speech —0.05 meter; whisper not heard: after piditzerization, speech 0.5 jilus meter. wdiis]>er not heard, 'the sensitiveness of the meatus and dnnn w'as normal, 'the mastoiil was hypersensitive, especially over the antrum.
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