[Reprinted from the Therapeutic Gazette for January 15, 1887. Galvanism and Bromide of Quinine in the Treatment of Chronic Catarrh of the Middle Ear. J. A. Patterson, M.D., Salem, N. J. CHRONIC catarrh of the middle ear and its usual attendant, tinnitus, is a disease whose treatment has never been very satis- factory. In the great forward strides made in both therapeutics and surgery at the present day the treatment of this affection has made com- paratively very little advance, therefore I offer these remarks, crude as I know they are, hoping they may be of some value towards the more successful relief of tinnitus aurium and progressive loss of hearing. I have many times been struck by the simi- larity of cinchonism and the symptoms of catarrhal deafness, and reasoned that quinine must have some specific action upon the mid- dle ear, for we know where cinchonism has been kept up in a patient for a lengthy period a chronic congestion of the middle ear is often produced, leaving impairment of hearing in greater or less degree, and often tinnitus. Reasoning from analogy, I determined to try the effect of quinine in small doses in such 2 cases, but in two instances in which I used the sulphate my patients derived no benefit. Now, it is a well-known fact that bromine in its various combinations, as bromide of potas- sium, sodium, etc., controls and lessens the blood-supply to the cranium, and will often mitigate somewhat the roaring which these patients experience in their diseased ears, so I thought that probably a combination of bromine and quinine would act better. Ac- cordingly I procured some bromide of qui- nine. The first patient upon whom I tried it was a lady with history as follows : Right ear : abscess three weeks ago ; drum membrane shows pin-point perforations, open- ing valve-like upon inflation of the middle ear ; watch heard at four inches. Left ear : hearing nil from purulent catarrh, which fol- lowed scarlet-fever in childhood, and existed up to the age of thirteen years. Deafness and tinnitus in both ears,-in left ear for a number of years, in right ear progressing for the past six or eight months. She consulted me very irregularly for several months, and was some- what improved by galvanism applied directly to the ear, one electrode, moistened with a saline solution, being introduced into the external auditory meatus, and various remedies. Upon May 20 I put her upon grain-doses of bromide of quinine t. i. d. In three days she returned, saying she had used the medicine faithfully, but it increased the tinnitus so much she had to abandon it, since which time it has de- creased to its usual intensity. She frankly stated she believed I had given her quinine, as she readily detected its usual effects upon her, and as I compounded the recipe in per- 3 son, I knew she had no opportunity of read- ing the prescription. I then gave the drug in |-gr. doses t. i. d., with slight improvement. June io I began giving it in doses four times a day, still continuing the use of galvan- ism, when the hearing began gradually to im- prove, until it reached in right ear nine inches for watch ; tinnitus greatly improved. She has now stopped treatment, saying she hears well enough, and the tinnitus is so slight as to cause no annoyance. The second case. Mrs. , set. 55, came to me for deafness of many years' duration and intolerable tinnitus of over a year's dura- tion. There was found to be a large perfora- tion in the membrani tympani of each ear, following aural discharges in very early child- hood. Watch could not be heard at contact in either ear. Under three months' treat- ment, by weekly applications of the galvanic current, and quinine bromide gr., four times a day, there has been a gradual im- provement in hearing, first by hearing the watch at contact, and on last consultation she reported having heard the entire sermon at church, sitting in her accustomed pew, the same clergyman as usual occupying the pulpit; the first sermon she had thus enjoyed for some years. The tinnitus has greatly and decidedly improved, and from being very despondent she is in much more cheerful spirits owing to its decrease. She is now out of town on a prolonged visit, therefore I have for the time lost trace of the case. Other cases in which I had begun giving this remedy have failed to report themselves, consequently no data can be thus obtained. 4 In conclusion, I would say that systematic, prolonged use of galvanism, combined with systemic treatment, will do more for the relief and cure of chronic catarrh of the middle ear than any mode of treatment I have yet tried (attention to the health of the nasal and pharyngeal mucous membrane, of course, never to be overlooked or neglected). It is necessary that the physician should know that the results are often slow and gradual, al- though in some instances very rapid results are obtained, as the following case will show : A. C. K., aet. 56, consulted me November 17 for tinnitus and deafness in left ear for past ten months, gradually increasing. Politzer's inflation shows Eustachian tubes patulous, although there exists a chronic rhinitis. Mem- brana tympani intact and of dusky hue. I prescribed an alkaline wash for the nose, and applied galvanism. November 23.-Since last consultation no tinnitus, and hears better. December 7.-Hearing improving ; momen- tary returns of the tinnitus noticed ; same treatment. December 29.-Been entirely free of tinni- tus for two weeks, which is the longest free- dom he has had for nearly a year. Hearing greatly increased, so as to be now, he thinks, normal. He then discontinued treatment. I close, hoping to be able to report con- tinued good results from the bromide of quinine treatment. 213 Broadway, December, 1886.