We investigated the frequency similarities of tinnitus in 150 patients (186 ears) and the relationship between the ear disease and the pitch of tinnitus. The tinnitus could be divided into three groups by the frequency similarity to pitch of tinnitus. 1) Tinnitus in 24.1% cases was limited to the low frequency ranges between 125Hz and 800Hz. 2) Tinnitus in 20.9% cases was limited to the mid-dle frequency ranges between 1KHz and 3KHz. 3) Tinnitus in 55% cases was limited to the high frequency ranges between 4KHz and 8KHz. In an attempt of study on the relationship between the frequency similaritiy of tinnitus and the frequency of the lowest audible threshold, the following results have been obtained. Regardless to tinnitus of the low, middle or high frequency pitch, the most of cases showed the hearing inpairment in the higher frequencies on pure tone audiogram.
In order to obtain useful findings for a clinical diagnosis of extrinsic causes of tinnitus, the influence of sound load was studied in 1, 354 cases. The sound load test was conducted in 707 cases of head trauma, 323 cases of noise trauma, and 324 miscellaneous cases. After 2 minutes loading with 2, 000Hz, 90dB, presence or absence of tinnitus, or change in tinnitus were recorded on the test side (loaded ear) and contralateral side (non-loaded ear) after recovery to pre-loading threshold. And the following results were obtaind: 1) The proportion of cases with a positive change was 30.75, 28.89 and 24.15% in the group of head trauma, miscellaneous group, and group of noise trauma, respectively. 2) The proportion of a positive change according to the property of tinnitus gradually decreasedd from the continuous group, to the intermittent group to the group without tinnitus, and the ratio of the change on the tested side also gradually decreased. 3) In the whole series and the group without tinnitus, the overall rate of positive change, the rate of positive change on the tested side, and the rate of positive change on the contralateral side all decreased with advancing age, giving a statistically significant difference (P≤0.05).
In order to investigate the characteristics of perceptive deafness unaccompanied with tinnitus. 298 impaired ears were studied from a statistical point of view. Chief findings were follow: 1) Of 298 impaired ears, 26.5% were unaccompanied with tinnitus at first examinations. 2) 35.4% (28ears) of impaired ears unacompanied with tinnitus had been noticed deafness in infant or newborne and 62.5% of impaired ears noticed in infant or newborne were not accompanid with tinnitus. 3) The rate of numbers of impaired ears unaccompanied with tinnitus was higher in old age than in the prime of life. 4) The rate of Numbers of impaired ears unaccompanied with tinnitus became higher as the periods from the begining of deafness to the first examination were longer. 5) According to the groups which were summed up by impaired ears with the constant periods of deafness, the rate of numbers of impaired ears unaccompanied with tinnitus became higher as the grades of hearing impairement increased. 6) According to groupes which were summed by impaired ears with the constant grades of hearing impairement, the rate of numbers of impaired ears unaccompanied with tinnitus became higher as the periods of deafness were longer.
Three cases of objective tinnitus were reported, 6-and 7-year-old boys and a 40-year-old house-wife. Their tinnitus occured involuntarily and were not ceased by pressure on the carotid artery, and they were not synchronized with the arterial pulsation. All three patients were suffering from infection of the upper respiratory tract before tinnitus begun, and there was no abnormality on the ear drums. The authors thought the tinnitus due to muscular contraction, especially of the salpingo-pharyngeal muscular. All treatments failed in the cessation of the tinnitus.
The authors observed eight cases of intermittent tinnitus which appeared during the course of recovery from peripheral facial nerve paralysis of various etiology. The tinnitus occurred whenever a certain mimic facial muscle contracted voluntarily or involuntarily. As the tinnitus in each case didn't dispaaeared by medical treatment or other conservative therapy, tympanotomy via extenal auditory meatus was made. Under the operating microscope, contraction of the stapedius muscle synchronous with contraction of the mimic facial muscle was observed. The tinnitus had disappeared completely immediately after the tendon of stapedius muscle was sectioned. Thus the existence of tinnitus due to abnormal contraction of stapedius muscle was confirmed. Further, tinnitus in each cases was considered to be an expression of abnormal associated movement involving the stapedius muscle during the course of the recovery from facicl nerve paralysis. Changes of the minimum audible. threshold (air conduction) were measured in each case during the stapedius muscle contracted without sound stimulation, and the results showed a good accordance to the results obtaind from the theoretical and experimental works which had been reported by several authors. In a conclusion, the authors stressed the importance of the stapedius muscle tinnitus in the study of pathogenesis of tinnitus, facial nerve paralysis, as well as in the study of middle ear function.
The author described explanatorily each the following items of the vascular objective tinnitus. 1 Discovery of objective tinnitus 2 Clinical characteristic of vascular tinnitus 3 Diagnostic method of vascular tinnitus 4 Cause of vascular tinnitus (Vascular lesion as sound source) 5 Incentive cause of vascular tinnitus 6 Medical treatment of objective vascular tinnitus 7 Relationship between the objective tinnitus and the subjective tinnitus
Since Barré (1926) has reported the “Posterior Cervical Sympathetic Syndrome”, much attention has been given to this syndrome. As the findings of tenderness on the occipital nerve region was of great interest, the author tried the great occipital nerve block in the case with tinnitus suspicious of the cervical syndrome. As the results, the excellent effect on tinnitus was recognized by this procedure, especially in the case with tenderness on the occipital nerve region, regardless to the existence of impaired hearing. It was named as “Cervical Tinnitus” and the standardization of the differential diagnosis of tinnitus was proposed as follows: 1) Tinnitus which diminished after the initial block of cervical orgin. 2) Tinnitus which was decreased after the initial block and subsided by the repeated ones was of cervical. 3) Tinnitus which decreased after the initial block and persists after the repeated ones was of cervical and other causes. 4) Tinnitus unaffected by this procedure was of other causes.