AURAL COMPLICATIONS IN MUMPS. WITH REPORT OF EIGHT CASES. BY JAMES L. MINOR, M.D., MEMPHIS, TENN. REPRINTED FROM THE Neto 'X'orit IfUetifcal journal for March 27, 1897. Reprinted from the New York Medical Journal for March 271897. AURAL COMPLICATIONS IN MUMPS. WITH REPORT OF EIGHT CASES. By JAMES L. MINOR, M. D., MEMPHIS, TENN. Parotiditis attracts little attention as a rule. The disease demands the interest of the general practitioner chiefly through its sequehe; and as the aurist is called in for only one of the rarer forms of these, and usually after it is well pronounced and established, the oppor- tunities for studying its aural complications are meagre. Thus far, it has been established that a small pro- portion of those attacked with mumps suffer also from ear disease, which may cause simple impairment of hearing, but usually absolute and permanent deafness in one or both ears. It usually comes on between the fourth and eighth days, and ordinarily declares itself by tinnitus, impaired hearing, dizziness, nausea, and finally labyrinthine deafness. Extension of the dis- ease from the parotid to the ear is variously attributed to metastasis; direct extension of the inflammatory pro- cess through fissures adjacent to the inner ear; from the outer to the middle ear, and thence to the labyrinth; or by way of the Eustachian tubes. Copyright, 1897. by D. AppmT?OX and Company? 2 AURAL COMPLICATIONS IN MUMPS. It is rare. Dr. Roosa found it in only ten cases out of five thousand ear patients treated at his office. I have collected the notes of eight cases-six seen by me, and two unreported cases, kindly placed at my disposal, from the notebooks of Dr. H. D. Noyes, of New York. A striking feature is the frequency with which the left ear is attacked. Of my cases, the left ear was affected in five, the right in one, and both in two. And I notice that Dr. Roosa's cases show a decided predi- lection for the left also-the left, six; the right, three; both, one. This may be a mere coincidence; but I de- sire to call attention to it because the general practi- tioner has noticed that when the testicle is involved in mumps it is most frequently the right. I may state that in all of my cases both parotids were involved. In none was the testicle affected. The most important points brought out by a study of my notes can be illustrated by grouping the cases as follows: 1. Those in which the ear trouble began and ended in the middle ear, three-Cases II, III, VII. 2. Those in which it began in the middle ear and extended to the inner ear, one-Case I. 3. Those in which it began and remained in the inner ear, three-Cases V, VI, VIII-and in none of these did there seem to be involvement of the semi- circular canals, the cochlea alone being affected. 4. Those in which it began in the inner ear, the semicircular canals, and extended first to the middle ear and later to the cochlea, one-Case IV. The frequent involvement of the middle ear certain- ly suggests the probability of benefit from treatment. AURAL COMPLICATIONS IN MUMPS. 3 And if these cases were promptly and intelligently treat- ed, instead of being consigned at once to the category of incurable affections, a large proportion of them would doubtless recover their hearing. Case I.-Mr. M. C., aged thirty-five years, seen September 1, 1881; stout, healthy man; mumps. June 6, 1881.-Both parotids involved. No orchitis. On June 9th, sense of fullness, with tinnitus, in the left ear, relieved by drawing auricle from head. This condition continued for a week, when dizziness ap- peared, and, after two days, difficult locomotion, with tendency to fall back and to the left. The dizziness and disturbance of equilibrium, after remaining some days, gradually grew less, and were almost absent when he came to me. I found the right ear normal. The left ear was deaf to all sounds-watch, voice, and tuning fork. Aside from slight retraction and a little dullness of the drums- about equally marked in each ear-nothing else could be found. He was treated a few times, and passed from observation. I saw this gentleman eight years later and his condition was the same. In this case the trouble evidently began in the middle ear, and probably extended thence to the inner ear. Early treatment would probably have prevented permanent effects. Case II.-A. B., a man, aged twenty-eight years, had a severe attack of mumps in January, 1883. All of the salivary glands were involved, and constitutional dis- turbance was considerable. No orchitis. On the third day, earache, with hard hearing and tinnitus, on the left side. I saw him a few hours later, and found injection around the entire periphery of the drum membrane and along the malleus handle; light spot indistinctly visible; no bulging (acute catarrh of middle ear); and hearing re- duced to one twelfth. Politzer's inflation was practised, 4 AURAL COMPLICATIONS IN MUMPS. with some relief, and the hot-water douche was used with much benefit. The next day the right ear became affect- ed in the same manner, and was treated similarly. Gradual improvement set in and resulted in a per- fect cure in about one week. This case was one of acute catarrh of the middle ear, doubtless due to direct extension of inflammation from the throat. Complete recovery was probably due to prompt recognition of the difficulty, and judicious treatment, which prevented the disease from extending to the deeper structures. Case III.-Miss A., aged seventeen years; mumps; February 9, 1891. Both parotids involved; not much general disturbance. On third day, pain, impaired hear- ing, and tinnitus in both ears. I found a slight amount of pus in each ear, removal of which revealed a small perforation in each drum membrane. Hearing, || in right, in left. Politzer's inflation and douching the ears with hot antiseptic solution daily resulted in a cure in ten days. This was a case of acute suppurative inflammation of the middle ear, also caused by direct extension of the disease, and the early treatment may have prevent- ed involvement of deeper structures. Case IV.-Mr. B., aged nineteen years (referred to me by Dr. M. B. Herman, of Memphis), seen May 18, 1894. Parotiditis, both sides, five weeks before. The at- tack was as follows: While at work, he became giddy and sick at the stomach; went home and to bed. Next day, be was too dizzy to get up; could not lie on the left side because dizziness was increased and nausea produced: the next day both parotids were inflamed and enlarged. He remained in bed four days longer. Then he got up with assistance and went to his office, took cold, and no- ticed for the first time that his hearing was dull on the AURAL COMPLICATIONS IN MUMPS. 5 left side; this dullness of hearing was relieved by pulling on the auricle so as to straighten the canal. The next day dull hearing came on again, to be temporarily re- lieved by pulling on the ear. After lasting an hour or so it passed off entirely. This occurred daily for six days, and then the deafness became complete and permanent -remaining in the condition which existed when I first saw him. Complains of absolute deafness in the left ear (tinnitus), and slight dizziness when sudden movements are made. The appearances of the drum membrane are normal. Tuning fork heard only in right ear. At times it seems that he hears loud sounds in the bad ear, but that is uncertain. Treatment advised, but not carried out. This case is interesting in that the process involved first the inner and later the middle ear. Whether the disease extended from the former to the latter, or di- rectly from the throat, can not be stated; but if treat- ment for the middle ear had been promptly instituted, I believe the hearing would have been preserved. Case V.-Miss W., aged fifteen years (referred to me by Dr. Isom, of Holly Springs, Mississippi), seen May 29, 1894. She had double parotiditis eighteen months ago, and has since been deaf in the left ear. There was no dizziness, nausea, or other symptom of labyrinthine involvement. Right ear normal. Left ear normal to all appearances, but deaf, absolutely, to all sounds-tuning fork and- others. This case was simply one of nerve deafness when I saw it. How it began, it is impossible to say. Case VI I saw with my associate, Dr. E. C. Ellett. The patient was one of Dr. John M. Maury's, and through his courtesy the following notes were obtained: Mrs. A., widow, white, aged twenty-eight years, was taken on February 28th with mumps, the left parotid swelling first, the right five days later. There were no unusual features, except that the pain 6 AURAL COMPLICATIONS IN MUMPS. on the left side was severe enough to necessitate an opiate for relief. March 12th.-Though there was still some swelling on the left side, she was feeling well, and on this day moved across the city. At 10 p. m. on the 12th, while standing, she suddenly became faint, lost consciousness, and fell to the floor. Shortly after being put to bed she regained con- sciousness and vomited. Temperature, 101° F.; pulse, 76 and weak. Nausea continued for ten days, though there was no more vomiting. 13th.-Feeling well but weak. Temperature in the mouth, 97° F.; pulse, 70. On the 13th, at 7 p. m., while in bed, she again sud- denly felt the extreme weakness, but did not lose con- sciousness, and, though more nauseated than during the day, she did not vomit. At this time her tempera- ture was 96° F. in the mouth; pulse, 54. This attack lasted three hours. April 18th.-Since the second attack she has been entirely deaf in the left ear. For a week there seemed to be a loss of muscular sense in the muscles controlling the head-i. e., on ris- ing up she would express herself as " not knowing just where her head was/' though motion was in no way limited. Her pulse was below normal in frequency for ten days, gradually reaching 70, and for the next week ranging between 76 and 90. Now, six weeks since the first attack, her tempera- ture has only on two occasions reached 98.5°, and at one time was as low as 95.5°. Since the first attack she has constantly had a roar- ing in the left ear, and has at all times complained of a tired aching in the spine. She has never at any time had vertigo. Examination of the ears showed the right one to be normal in every respect. The left was deaf, absolutely, AURAL COMPLICATIONS IN MUMPS. 7 to all sounds. The drum membrane was somewhat re- tracted and a trifle thickened, but did not depart great- ly from health. In this case the trouble was in the labyrinth. Whether the condition of the middle ear had any con- nection with the deeper structures or with the parot- ids can not be stated. Case VII.-Mrs. W. P. B., aged thirty years (page 368, Dr. H. D. Noyes's notebook). Parotiditis at ten years, leaving trouble with the left ear, which has existed since. Has nasopharyngeal catarrh, and her hearing is worse with colds. Membrana tympani thick and retract- ed. Hearing voice brought up to two inches by Politzer. Eight ear, hearing normal, though membrane is a little sunken. This case was purely one of involvement of the middle ear from beginning to end. Case VIII.-H. W., aged thirteen years (page 405, notebook of Dr. H. D. Noyes). Mumps at two years, no ear trouble. Again, severe attack of mumps at eleven years; was delirious for a short time, and on recovery was deaf in the right ear, without tinnitus, dizziness, or other symptom. Is a nervous, weak child. Had epi- leptoid convulsions when eight years old, and when nine, had a fall, striking on the head. Sudden rising from bed causes headache, and sometimes dizziness. No dis- turbance of locomotion. Hearing hard to measure; but probably hears nothing in the right ear, and normally in the left. The membrana tympani is a little opaque on the left, opaque and sunken on the right side. This case was one which began and ended in the inner ear. The New York Medical Journal. A WEEKLY REVIEW OF MEDICINE. EDITED by FRANK P. FOSTER, M.D. THE PHYSICIAN who would keep abreast with the advances in medical science must read a live weekly medical journal, in which scientific facts are presented in a clear manner; one for which the articles are written by men of learning, and by those who are good and accurate observers ; a journal that is stripped of every feature irrelevant to medical science, and gives evidence of being carefully and conscien- tiously edited ; one that bears upon every page the stamp of desire to elevate the standard of the profession of medicine. Such a journal fulfills its mission-that of educator-to the highest degree, for not only does it inform its readers of all that is nevz in theory and practice, but, by means of its correct editing, instructs them in the very important yet much-neglected art of expressing their thoughts and ideas in a clear and correct manner. Too much stress can not be laid upon this feature, so utterly ignored by the " average " medical periodical. Without making invidious comparisons, it can be truthfully stated that no medical journal in this country occupies the place, in these par- ticulars, that is held by The New York Medical Journal. No other journal is edited with the care that is bestowed on this ; none contains articles of such high scientific value, coming as they do from the pens of the brightest and most learned medical men of America. A glance at the list of contributors to any volume, or an examination of any issue of the Journal, will attest the truth of these statements. It is a journal for the masses of the profession, for the country as well as for the city practitioner; it covers the entire range of medicine and surgery. A very important feature of the Journal is the number and character of its illustrations, which are unequaled by those of any other journal in the world. They appear in frequent issues, whenever called for by the article which they accompany, and no expense is spared to make them of superior excellence. Subscription price, $5.00 per annum. Volumes begin in January and July. PUBLISHED BY D. APPLETON & CO., 72 Fifth Avenue, New York.