The Results of High Explosives on the Ear (medical article 1920)

[catfishmo]

THE RESULTS OF HIGH EXPLOSIVES ON THE EAR

by J. Gordon Wilson, M.A., M.B., C.M. (Edin.)

From: Transactions of the Eighth Annual Meeting of the Pacific Coast Oto—Ophthalmological Society 1920. Page 74-92 Online here

In researching deafness caused by shell explosions, I found a most informative article by an otologist who saw cases at casualty clearing stations (fresh cases), stationary hospitals (few days after injury), and an eye ear specialty hospital in Folkestone (long term treatments and prognosis).

In summary battlefield deafness is generally caused by two things:

-Perforation of eardrum and/or

-Concussion (either by blunt force trauma or air pressure concussion)

The article deals mostly with concussion. He gives an example that best explains what causes this:

"To put it roughly, there is not one telephone wire from the ear to the receiving and interpreting station in the cortex. The path is broken at various synapses or junctions or telephone exchanges. At these synapses connection is made with other nerve paths, and communication can be and is established with other physiological systems. What the significance of this probable interchange may be we do not know."

So concussive explosions interrupt these delicate synapses therefore impairing hearing. The article goes on to detail common symptoms (nausea, vertigo, tinnitus, headache), numerous very interesting cases, treatment with tuning forks, resonators, and voice.

I've pasted his summary:

92-Summary

1. In deafness resulting from concussion due to high explosives, there is frequently a trauma demonstrable in the ear. The perception of sound is diminished over the whole normal range both for bone and air conduction. This diminution may be so great as to totally abolish perception of sound.

2. In the totally deaf who improve, bone conduction is perceived before air conduction. In these cases summation of stimuli plays an important part in the perception of sound. It is essential to differentiate vibrations from musical notes.

3. There is a marked diminution of the duration of hearing along the whole series of forks, both through bone and air.

4. The normal stimulus (musical notes or voice) is an adequate stim ulus for the nerve and is the best stimulus. Electricity is contraindicated and likely to do harm since it so easily produces vertigo.

5. If the conducting mechanism is damaged or destroyed, it not only takes longer to get improvement, but complete recovery cannot be expected.

6. As the deafness diminishes there may persist for a long time an inability to grasp intelligently what is said or to retain the memory of it. Thus a word may have to be repeated two or three times before the patient gets it; or, if he be asked to repeat two or three numbers given consecu tively, he will repeat the last one; he knows that there were others but “did not get them.”

7. Pathological examinations show that the auditory mechanism may be seriously damaged while the vestibular shows little or no change. There fore the vestibular mechanism may react to stimulation in cases where the cochlea is seriously damaged.

8. Prognosis is good, as a rule, especially in cases Where there is no trauma demonstrable in the peripheral organ, no marked history of aural vertigo, and a normal caloric reaction. The most noteworthy exception met with so far is damage to the seventh nerve. In these cases, if hearing returns, it returns but slowly, and so far as we have observed very imperfectly even with a normal drum membrane, little if any signs of middle ear inflammation, and a caloric reaction present.

I took a few pages of notes of specific interest to me as an author. If you would like a copy, PM me. I would be happy to share them.

~Ginger