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“but being deaf, the Spirit not the Body tires” – the Duke of Wellington’s Hearing Loss

Hugh Dominic WStiles3 May 2019

Arthur Wellesley, the Duke of Wellington, who was born 250 years ago, in 1769, suffered from noise-related hearing loss caused by artillery.  William Wright tells us,

The Duke of Wellington was inspecting an experimental carriage for a howitzers and whilst in advance of the gun, gave the word ” Fire ;” the result was the rupture of the membrane of the drum of the left ear. The Duke went immediately to Mr. Stevenson who told his Grace the story, about thickening the drum of the ear. The solution of caustic was applied; instant pain ensued, from the caustic passing through the ruptured membrane amongst the ossicula, and very sensitive internal tissues. Within six hours the Duke was conveyed home from Lord Liverpool’s, in a state of insensibility, and it was only by most careful, skilful treatment that his life was then preserved. He went to Verona, a great sufferer, and the country had very properly to make a handsome compensation to Dr. Hume, and his family, for giving up his practice to attend the Duke on his mission. (Wright, 1860, p.75-6)

Graham Smelt says that this was on On August the 5th, 1822.  His hearing loss was made considerably worse by the botched treatment, a story related by a Mr Gleig, in an anecdote that suggests it was Hume who was to blame –

The Duke, many years ago, being deaf, sent for his medical man, who poured some stuff into his ear, not knowing that the drum of the ear was broken. This proved very mischievous in its results. The Duke said it was not sound that was restored to him; it was something terrifically beyond sound: the noise of a carriage passing under his window was like the rolling of thunder. Thus suffering, he returned home about the middle of the day, and went to bed. Next day, Dr. Hume called and found the Duke staggering about the room. Dr. Hume, although he well knew the Duke’s temperate habits, supposed that he had taken a little too much wine overnight, and had not recovered from it. He was leaving the room, when the Duke said to him : Hume, I wish you would look to my ear ; there is something wrong there.’ Hume looked and saw that a furious inflammation had begun, extending to the brain ; another hour, and the stuff would have done for the Duke what all his enemies had failed to do : it would have killed him. Hume bled him copiously, sent for Sir Henry Halford and Sir Astley Cooper, who treated him with great skill, and brought him round. The poor man came next day and expressed his great regret. The Duke spoke to him in his kindest manner and said, I know you did not mean to harm me ; you did your best, but I am very deaf.’ Upon which, the Doctor said, I am very sorry for it ; but my whole professional prospects are at stake, and if the world hears of it I shall be ruined.’ ‘The world need not hear at all about it,’ said the Duke; ‘keep your counsel, and I’ll keep mine.’ The Doctor, encouraged by this, went a little further : Will you let me attend you still, and let the world suppose that you still have confidence in me ?’ ‘No, no,’ said the Duke, ‘I cannot do that ; that would not be truthful.’ (Davies, 1854 p.16-17)

To me this sounds like a well-rehearsed anecdote, but there is something ‘missing,’ it seems to me, in Wright’s account, in that he seems to imply that Hume had some hand in the affair without explicitly saying so.  Or is he just omitting Stevenson’s name, and ‘the poor man’ is Stevenson?  Smelt says that Stevenson was to blame, and that Hume treated him afterwards.  In an earlier book, Wright tells us –

Deleau states that he can reach the cavity of the tympanum by a bent probe, or catheter. If he even can do so, which I consider is very problematical, I am convinced the operation is attended with considerable danger, for the ossicula (the small bones) which extend from the inside of the membrana tympani, to the opposite side of the cavity, would be in great danger of being forced from the situation in which Providence has been pleased to place them, or their functions would be otherwise diminished, or destroyed, and such would be the effect of any injury being inflicted on this delicate organization, that inflammation of the brain, and even death, would be a probable consequence. An example of this was unfortunately nearly afforded about the end of 1822, or beginning of 1823, in the case of the Duke of Wellington, a lotion of lunar caustic had been dropped into the external auditory passage, there was an opening at the time through the membrane (or drum), from an accidental cause, and the caustic lotion entered the cavity beneath, containing the highly sensative [sic] integuments, and machinery therein placed ; the results were intense pain; in a few hours inflammation of the brain, with symptomatic fever, and his life was only preserved by the most prompt and efficient treatment pursued by his Physician, aided by other medical and surgical advice derived from the first men of the age. In June, 1823, I was called into attendance on his Grace, as his aurist, and continue still to attend him when necessary ; even at this distant period from the unfortunate occurrence, the Duke feels sufficient unpleasant effects occasionally, not to allow him to forget it, independent of the privation of his left ear.* Similar, if not even worse, must necessarily be the consequence of introducing an instrument into the cavity of the tympanum, even if the patient be in a state of health; but if there exist any tendency to inflammatory action, scrofula, or erysipelas, the danger is increased, and the disastrous effects, or even fatal termination of the experiment, for it is nothing more in ninety-nine cases out of a hundred, unavoidable. (Wright, 1839, p.55-7)

* In pp. 159 and 160, of “An Exposition of Quackery and Imposture in Medicine,” written by Dr. Caleb Ticknor, of New York, republished in this country, which I edited, and upon which I wrote copious notes, will be found a further account of the Duke of Wellington’s case.

Note how free doctors were then with patient information, while the patient was still alive. Smelt suggests as well as the seriously damaged ear, he also had noise-induced hearing loss in his other ear as he got older.

In 1852 the Duke wrote in a letter,

I have none of the infirmities of old age I excepting Vanity perhaps. But that is a disease of the mind, not of the Body ! My deafness is accidental ! If I was not deaf, I really believe that there is not a youth in London who could enjoy the world more than myself or could bear fatigue better, but being deaf, the spirit, not the body, tires. One gets bored, in boring others, and one becomes too happy to get home. (Wellington, 1854, p.314-5)

Losing his hearing had other consequences, as we see from this on February 20th, 1848 from the Greville memoirs –

At the House of Lords on Friday night, for the Committee on the Diplomatic Bill. Government beaten by three, and all by bad management ; several who ought to have been there, and might easily have been brought up, were absent : the Duke of Bedford, Duke of Devonshire, Lord Petre, a Catholic, dawdling at Brighton, and Beauvale. The Duke of Wellington, with his deafness, got into a complete confusion, and at the last moment voted against Government. (Greville, 1888, p.129)

When he was in his eighties, as members of Derby’s 1852 government were announced, the now quite deaf Duke kept repeating, “Who? Who?”  It became known as the “Who? Who?” ministry.

Davies, George Jennings, The completeness of the late duke of Wellington as a national character, 1854

Greville, Charles Cavendish Fulke, The Greville Memoirs: A Journal of the Reigns of King George IV, King … 1888

Hazlitt, William, ed, Arthur Wellesley Duke of Wellington, The Speeches of the Duke of Wellington in Parliament, Volume 2, 1854

Smelt, Graham, Wellington’s Deafness. Abstract presented at the meeting British Society for the History of ENT, Held December 1st 2011 In the Toynbee McKenzie Room, at the Royal Society of Medicine, London

Wright, William, A few minutes’ advice to deaf persons…, 1839

Wright, William, On the varieties of deafness and diseases of the ear, 1829

Wright, William,  Deafness and Diseases of the Ear: The Fallacies of Present Treatment Exposed … 18

Tinnitus in the media…

Hugh Dominic WStiles9 February 2018

Tinnitus frequently appears in newspapers and online news sources. Because anyone who suffers from a chronic condition can get frustrated, despressed and angry at the inabilty of medical science to cure the condition, that makes people ready to grasp at anything that could give them hope, offering to alleviate or cure the condition. Tinnitus is no exception, and below are a few recent stories that cover it, all in this case from the Daily Mail, though other papers and websites could equally have been included.

It pays to be a little sceptical with health stories.  Always ask yourself the questions –

  • who produced the study or studies behind the story?
  • are they reputable researchers, or are they selling something?
  • has the article given the original source where the study is published?
  • is the newspaper story written by someone who knows what they are writing about, or is it a staff writer who is regurgitating a press release which has a positive spin?
  • If the study is based on a group of patients, was it a small number or a large number?

I am not saying these stories are invalid, but the headlines are never written by the author, and they often disguise the facts.  People come away remembering the headlines, not the complete story.  Read these stories, but with caution.

Do YOU suffer from tinnitus? Study reveals ‘resetting’ brain cells using electric currents can alleviate the misery of phantom sounds
Read more: http://www.dailymail.co.uk/health/article-5232433/Study-reveals-resetting-brain-cells-cure-tinnitus.html#ixzz56cL3gYau

Google alert helps to end a former Royal Marine’s 10-year tinnitus hell: Notification highlighted pioneering IPOD-based therapy that has allowed veteran to ‘function again as a human being’
Read more: http://www.dailymail.co.uk/health/article-5030949/Royal-Marine-tinnitus-finds-relief-IPOD-therapy.html#ixzz56cMfslW7

Fed up with the noise of modern life? FEMAIL reveals how at home EAR YOGA can help
Read more: http://www.dailymail.co.uk/femail/article-5337717/Fed-noise-modern-life.html#ixzz56cV58VzY

Tinnitus Awareness Week 2018 – Suggested reading

Hugh Dominic WStiles8 February 2018

Tinnitus is an active area for research, because it bothers so many people.  Even if you do not have it, there is a good chance you know someone who has it in some form, ranging from a minor irritation to a serious frustration.  People are looking for cures, but management of the condition seems the most realistic solution for most people.  Here are a few suggested books that might help those who have tinnitus.

For non-experts –

Living with tinnitus and hyperacusis, by Laurence Mckenna, David Baguley and Don McFerran, 2010.

This book has 4 or 5 stars in 75% of the Amazon.co.uk public reviews.

Tinnitus: Questions and Answers, by Jack Vernon and Barbara Sanders, 2001. ISBN-13 978-0205326853

“The questions in this book are from patients. The answers are written for patients and for interested health care providers too. The book covers causes, treatments, and other topics with a format similar to the column written by the author in “Tinnitus Today” magazine.”

For Experts –

Tinnitus Retraining Therapy: Implementing the Neurophysiological Model, by Pawel Jastreboff and Jonathan Hazell, 2004.  ISBN 0521592569

‘One of the nice things about being asked to review a book is that you get to keep a copy if it – and this is certainly a book well worth keeping. This is a thought-provoking and stimulating book for dipping into, for referring to, for speed-reading and for reading thoroughly from cover to cover. It will be a useful addition to the shelves of professionals who work with people with tinnitus.’ Tinnitus Focus

Tinnitus, by by David Baguley, Gerhard Andersson,‎ Don McFerran,‎ Laurence McKenna, 2nd edition 2013. ISBN-13: 978-1405199896

‘The 2nd edition has been thoroughly updated and revised in line with the very latest developments in the field. The book contains 40% new material including two brand new chapters on neurophysiological models of tinnitus and emerging treatments.’

Tinnitus Awareness Week – Patient Information

Hugh Dominic WStiles8 February 2018

By Abir Mukherjee @ClinicalLibUCLH

Tinnitus Week is an international event raising global awareness of this condition taking place from 5-11 February 2018. The aim of the week is to raise awareness of the condition. This blog post gives a quick overview of some patient information sources, all of which meet NHS England’s patient information standard.

The Action on Hearing Loss website has a number of free factsheets on its website in addition to a tinnitus helpline number: https://www.actiononhearingloss.org.uk/hearing-health/tinnitus/

The British Tinnitus Association believes the condition affects approximately 1 in 10 of the population in the UK. Other details about tinnitus awareness week, information sheets, and a helpline can be accessed at their website: https://www.tinnitus.org.uk/h-blog

The website also has a case study of living with tinnitus which is now on BBC news.

NHS Choices defines tinnitus as ‘hearing sounds that come from inside your body, rather than from an outside source’ with sufferers describing ‘ringing in the ears’ or ‘buzzing; humming; grinding; hissing or whistling.’ As a starting point for most patient information it can be accessed at: https://www.nhs.uk/conditions/tinnitus/

An overview of symptoms and treatment options is also available from the Patient.co.uk website at: https://patient.info/health/tinnitus-leaflet

ENT UK, a professional membership body that represents Ear, Nose and Throat and its related specialities also has patient information on tinnitus that can be downloaded from: https://www.entuk.org/sites/default/files/files/ENT/About%20Tinnitus%206pp%20DL%20%2809028%29_7_16.pdf.

Tinnitus Awareness Week 2018 – recent research articles on Tinnitus

Hugh Dominic WStiles8 February 2018

By AbirMukherjee @ClinicalLibUCLH

This blog post examines a small selection of recent research articles on tinnitus in the journal literature following a search on MEDLINE, EMBASE and PsycInfo databases, limited to the last two years.

Philips et al (2018) cautiously provide statistical evidence that tinnitus generally improves over time, albeit the effect is highly variable across individuals. Their systematic review and meta-analysis focusses on the natural history of the condition by evaluating long-term progression in participants in the no-intervention control arm of clinical trials.

Wang et al (2018) in another systematic review and meta-analysis focus on the effects of direct current stimulation (tDCS) on patients with tinnitus, as previous studies on tDCS have discussed a reduction in symptoms but demonstrated variable results. They conclude that the pooled results demonstrate a greater reduction in distress for groups treated with tDCS as compared with those administered a sham treatment.

A smaller recent RCT by McKenna et al (2017) investigated whether mindfulness-based cognitive therapy (MBCT) could offer an effective new therapy for tinnitus. The results showed that treatment was effective regardless of initial tinnitus severity, duration, or hearing loss. The authors concluded MBCT is effective in reducing tinnitus severity in chronic tinnitus patients compared to intensive relaxation therapy by reducing psychological distress and disability. As limitations, future studies need to look at the generalizability of this approach and how outcome relates to different aspects of the intervention.

A systematic review in 2017 on environmental noise and permanent hearing loss and tinnitus (Śliwińska-Kowalska et al 2017) found a positive correlation between noise level and hearing loss either at standard or extended high frequencies. However only a limited number of studies met their inclusion criteria and the authors acknowledge that all of the evidence was of low quality. They recommend future studies to provide actionable guidance for personal listening device users.

All of these articles are available at the UCL Ear Institute & Action on Hearing Loss Libraries – contact staff for help accessing full text.

References

McKenna, L., Marks, E.M., Hallsworth, C.A. and Schaette, R., 2017. Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Tinnitus: A Randomized Controlled Trial. Psychotherapy and psychosomatics, 86(6), pp.351-361.

Phillips, J.S., McFerran, D.J., Hall, D.A. and Hoare, D.J., 2018. The natural history of subjective tinnitus in adults: A systematic review and meta‐analysis of no‐intervention periods in controlled trials. The Laryngoscope, 128(1), pp.217-227.

Śliwińska-Kowalska, M. and Zaborowski, K., 2017. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Permanent Hearing Loss and Tinnitus. International journal of environmental research and public health, 14(10), p.1139. OPEN ACCESS

Wang, T.C., Tyler, R.S., Chang, T.Y., Chen, J.C., Lin, C.D., Chung, H.K. and Tsou, Y.A., 2018. Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review. Annals of Otology, Rhinology & Laryngology, 127(2), pp.79-88.

“… we can easily mop the orifice …” – Macnaughton Jones and Tinnitus

Hugh Dominic WStiles12 February 2016

jones 1The Irish otologist, gynaecologist and ophthalmologist Henry Macnaughton Jones was the son of Thomas Jones, a doctor from Cork (see obituary for what follows).  He spent most of his early career locally, founding the Cork Eye, Ear and Throat Hospital, which was later known as the Victoria Hospital.  Moving to London in 1883, he concentrated on obstetrics and gynaecology.  He married when he was only twenty-two, and in the 1911 census we can see that there were three surviving children.  His obituary tells us that “His Handbook on Diseases of the Ear and Naso-pharynx passed through six editions”.

jones 6 titleThe book we are interested in today,Subjective Noises in the Head and Ears: Their Etiology, Diagnosis and Treatment was published in 1891.  He dedicated the book to the pioneer ‘Father of Modern Scientific Otology’, Dr. Adam Politzer , who perused the text and “did not consider it necessary to add any notes to the work.”  (Weir and Mudry, p.104, Macnaughton Jones, p.iv).  Jonathan Hazell surveys this book, one of the few that cover tinnitus at that period.  Macnaughton Jones follows on from Jean Marie Gaspard Itard (1775-1838), famous for  his work with the ‘wild Boy of Aveyron’, as a pioneer of tinnitus research.

One method that Macnaughton Jones tried to treat tinnitus, was with a galvanic battery, though he was not convinced of its use.  “It is uncertain in its effects, frequently causing grave aggravation of the subjective noises […] The dosage of it is difficult to measure.  In the hands of those not accustomed to electrical manipulation it is a mosyt haphazard treatment in that form of nerve disturbance that requires technical skill in manipulation, and fineness of adjustment in appliance. (p.128-9)

Our copy is signed ‘with the author’s compliments’.  The book is illustrated throughout with pictures of instruments that are laible to induce a shudder in those of a nervous disposition, such as Turnbull’s Eustacian Forceps, Eustachian Tube Electrode, Knife for Paracentesis Tympani, Mr Adam’s Septum Punch, a Nasal Saw and ‘The Author’s Nasal Shears’!  In his chapter, Treatment – the Middle Ear, he discusses tympanic catheters –

If the surgeon is determine to try to inject the tympanum through the Eustachian tube, it is as well to use one of Weber-Liel’s tympanic catheters, with a Pravaz syringe.  With this appliance, if the Eustachian tube be papent, we can safely inject the tympanum with the desired solution (vide “Handbook,” Fig. 46).  With such forceps as that of Turnbull (Fig.50), we can easily mop the orifice of the Eustachian tube and the posterior nares with any solution we desire.  I must confess that I do not of late resort to the use of chloride of ammonia vapour as frequently as I used to.  Still, it is a remedy worth trying in those cases of tinnitus in which we have general naso-pharyngeal relaxation and accumulation of mucus in the naso-pharynx and the Eustachian tubes.  It matters little which inhaler we use, provided we get the neutral fumes for imnhalation.  Kerr’s inhaler was one of the first used, and it is a very simple one.  […] If we desire to pump some of this vapour or that of iodiner into the tympanum through the Eustachian tube, we can easily do so by means of my autoinsufflating bag.

Some years since I had cigarettes made containing iodoform and eucaluptus for smikong purposes.  I found that the iodoform was in great measure disguised by the eucalyptus, and more so, by vanillin or coumarin

I have had them made with a little crowsfoot leaf.  These can be smoked through the nose, and some of the vapour may be passed behind the naso-pharynx, or by Valsalva’s method, into the tympanum.*

*Messrs. Corbyn, Stacey and Co.

We also see illustrated below, massage techniques, and he says that while “I do not pretend to explain how it acts, but it has in some cases decidedly beneficial effect”.

Macnaughton Jones died in Hampstead, in 1918.

jones 5 koniontronjones 4 menthol inhalerjones 3 terapeutical

HENRY MACNAUGHTON-JONES, M.D., M.Ch., M.A.O., F.R.C.S.I. and Edin, Br Med J 1918;1:521 B doi: http://dx.doi.org/10.1136/bmj.1.2992.521-a (Published 04 May 1918)

Hazell, Jonathan, Tinnitus, (1987)

Weir, Neil, and Mudry, Albert, Otorhinolaryngology : an illustrated history (2nd ed., 2013)

Census 1911 Class: RG14; Piece: 601

“One of the jolliest of men”, tinnitus, & a tragic suicide – “Salmon’s Reading Teas were then well-known and liked…”

Hugh Dominic WStiles5 December 2014

The Salmon family ran a tea and coffee merchant business in Reading in the 19th century.  Joseph Smith Salmon was born in Reading in 1846, son of Joseph Smith senior, who had expanded into the tea trade from his grocer’s business.  Joseph junior married Emmeline Foulger Tubbs in Stockport in 1878 (see Free BMD, Marriages Mar 1878 Stockport 8a 130).  In neither the 1851 census when 5, nor the 1861 census when he was 15, was he described as deaf, however the article on him in Ephphatha from 1896 says that his hearing loss was from Scarlet Fever aged 8 (1854)*.  In the 1871 census he is described as ‘Deaf and dumb from scarlet fever’.  He was described as ‘Deaf and partially dumb’ in the 1881 census.  He had been a pupil at the Old Kent Road Asylum from February 1857 until Midsummer 1860 according to school records (information via ), which is how he would have known Dr. Elliott (see below).

The Rev. Gilby tells of a visit to Reading, where Salmon was starting a mission in the 1880s.

“Joe Salmon” was a devoted follower of Matthew R. Burns, and I received an invitation to go to a tea-party of his to interpret the speeches.  I accepted, and on Friday, 18th January, 1885, Mr. J. P. Gloyn, our North London Missionary,  and myself went down to Reading from Paddington in the morning, saw the lions of the place together, and went to 11, Abbot’s Walk, where the Salmons then lived.  Here we met Mr. Richard Elliott, of the Margate School, Mr. J. Barber, of Brondesbury (who took private oral pupils: a man of sincere religious fervour whom we all respected), Mr. A. Pine Lilly, a deaf printer from London, whom I afterwards came to know very well indeed.

Salmon 3
[…]
We were all taken to Mr. Salmon’s tea-party in carriages – to the Victoria Hall in King’s Road. Immense pains had been taken to ensure the success of the occasion : beef, ham, rabbit-pies, plum-pudding, trifle, crackers – all these things figured on the menu. There were only about forty Deaf, but there were 170 of their friends; and more came after tea.  A Rev. – Tubbs (uncle of J. Salmon) said grace, and speeches were made, with Mr. Tubbs in the the chair.  Mr. Ernest Abraham, now in Australia, turned up, and a magic-lantern show was given, which my diary describes as “childish”.**  Prizes were distributed to the Deaf grown ups for attendance, as if they were children; and Mr. G. Palmer, M.P., who came in late, said a word or two.  Mr. B.H. Payne, of Swansea, also came late, and, like myself, slept at the Lodge Hotel at Mr. Salmon’s expense. In later years I attended similar parties, and remember meeting Dr. Stainer and Dr. Buxton at one of them, as guests of the Salmons when they had moved elsewhere in Reading.

Salmon 001Joseph died on August the 12th 1896, aged only 50.

The obituary in British Deaf Mute tells of the discovery of his body and the inquest at the Roebuck Hotel;

For some time Mr. Salmon had been suffering from insomnia, following upon an attack of influenza. He left home on Wednesday, August 12th, without leaving any message as to where he was going.  As he did not return, inquiries were made by his friends, and advertisements inserted in the local papers […].  Nothing, however, was heard of his whereabouts until Sunday evening, August 16th, when a man named Oliver Collins found the body of the deceased in the river near Tilehurst Station, Reading […]

It was evident that the deceased had been in the water from Wednesday til the Sunday.  The Jury returned a verdict of “Suicide by drowning during temporary insanity.”

Gilby says,

He had long suffered terribly from noises in the head and polypi, and we were not very much surprised when it happened. He had called on us at St. Saviour’s about a fortnight before, in the company of his father, and hinted at it in the course of conversation.  But as he was in the charge of his father we could only rally him cheerily and bid him dismiss such ideas from his head.   His body was found in the Thames at Pangbourne in an up-right position, and his watch indicated the hour of the occurrence of the tragedy.  He was a kind, but excitable man, and we felt great affection for him.

His son, Joseph Harold Salmon would have then been 18, and he had three daughters, Katherine, Gladys, and another daughter born in 1893, Doria Notcutt Salmon.  One child died young.Salmon Mrs

His father, Joseph senior was involved in an Old Bailey court case when he was younger, which explains the ‘Smith’ in his name – see here.  Joseph Smith Salmon senior died aged 86 in 1907, and writing some thirty years later Gilby said that “Salmon’s Reading Teas were then well-known and liked but since Joe Salmon’s death little has been heard of them.”  I wonder when the business finally folded, but suspect it was in 1907, as Joseph Harold was working for the Inland Revenue in 1911, living with his mother and youngest sister in West Norwood.

It is very poignant that Gilby called him in Ephphatha, “One of the jolliest of men”, only months before his death (p.63).

Salmon 2

*Curiously, though not unusually, for these details depended on who wrote the details down and whether someone chose to reveal information, he was not described as deaf in the 1891 census, when he was living at 46 Eastons Avenue, Reading.

**Gilby cannot resist a swipe at Abraham – see a previous post on Gilby.

UPDATED 8/12/14 to reflect the Ephphatha article for which many thanks to

The Late Jos. Salmon, Junr, The British Deaf Mute, 1896, p.285

Free BMD

1851 Census, HO107; Piece: 1692; Folio: 392; Page: 27

1861 Census, RG 9; Piece: 746; Folio: 75; Page: 20

1871 Census, RG10; Piece: 1281; Folio: 98; Page: 2

1881 Census,  RG11; Piece: 1305; Folio: 120; Page: 25

1891 Census, RG12; Piece: 998; Folio: 97; Page: 16

1911 Census, RG14; Piece: 2125

Gilby’s unpublished memoirs

Our Portrait Gallery, No.5, Ephphatha, April 1896, p.62-3

Tinnitus prevalence

Hugh Dominic WStiles1 March 2013

Recently we had an enquiry about tinnitus prevalence.  What follows is based on the information I uncovered trying to give an answer to that enquiry.

The figures for tinnitus will depend on a number of factors, for example the type or duration of tinnitus, and demographics, the subjective nature of tinnitus, the type of questions you ask people when you do a survey, and so on.  There will of course be other cautionary points to consider, such as the size of a sample, and other cultural or health related factors.

Back in 1987 the ‘MRC Institute of Hearing Research’ under Adrian Davis , discussed prevalence based on the National Study of Hearing (NSH) & the General Household Survey (pages 46-50), aged 17 and over in the UK (in chapter 3 “Epidemiology of Tinnitus” in Hazell (ed) Tinnitus p.46-70).  They estimated–

  • That 35-45% of adults have experienced tinnitus of some type.
  • About 15% of adults appear to have experienced spontaneous tinnitus lasting  over 5 mins.
  • At least 8% experience tinnitus causing interference with their getting to sleep & or moderate annoyance. “This would suggest about 4 million adults in the UK being affected”.
  • 0.5% report their tinnitus has a severe effect on their ability to lead a normal life “this amounts to 200,00 persons in the UK”.

In Tyler’s Tinnitus Handbook (2000), Davis quotes (chapter 1 p.4-5) the NSH based on – 

Postal questionnaires (“see Davis 1989”)

  • About 10.1% of adults experience prolonged spontaneous tinnitus.
  • 5.1% reported unilateral tinnitus.
  • 5% bilateral tinnitus.
  • That “the major indicator in this study was tinnitus annoyance. The study showed that about 5% had tinnitus which is moderately or severely annoying.”
  • 5% reported sleep disturbance. There was a considerable overlap with tinnitus annoyance such that 6% suffered either sleep disturbance or moderate-severe annoyance or moderate-severe annoyance or both.
  • The prevalence rate for a severe effect on quality of life was lower than those who had moderate-severely annoying tinnitus at about 1%.
  • Prevalence of those who reported a severe effect on ability to lead a ‘normal’ life was even less at 0.5%. “While this latter figure seems small it represents a large number of people: 200-250,000 in the United Kingdom and in excess of one million in the United States.”

From in clinic examinations

  • That increased age was important – 4.3% tinnitus in the in 17-30 age group, 15.8% in the 61-70 age group.
  • Slightly more females than males had tinnitus (p.12-13).

Overall then he concludes (p.6)

  • That there is a 10.1-14.5% prevalence, and up to 22 to 32% if the criteria are relaxed to include occasional tinnitus following noise or the common cold.
  • That 3-4% of adults consult a family doctor about tinnitus at least once in a lifetime with a similar percentage consulting about a hearing problem and tinnitus, “an indication of the magnitude of the problem”.

It seems to me it would be better if people stuck with, and quoted, percentages at a certain date/place where an article gives them, rather than trying to extrapolate for the population to best guesses in the millions.

Dr Laurence McKenna on Tinnitus

Hugh Dominic WStiles19 July 2012

Congratulations to the Royal National Throat Nose and Ear Hospital’s Dr Laurence McKenna, who has been awarded the British Society of Audiology (BSA) Thomas Simm Littler Prize for 2011.

Among other publications he has contributed to this book-

Laurence McKenna, David Baguley and Don McFerran, Living with tinnitus and hyperacusis. London:   Sheldon, 2010

And these are some of his recent articles –

Caffeine abstinence: an ineffective and potentially distressing tinnitus therapy.

Claire LS, Stothart G, McKenna L, Rogers PJ.

Int J Audiol. 2010 Jan;49(1):24-9.

PMID: 20053154

Andersson G, McKenna L.

Acta Otolaryngol Suppl. 2006 Dec;(556):39-43. Review.

PMID: 17114141

Hallam RS, McKenna L, Shurlock L.

Int J Audiol. 2004 Apr;43(4):218-26.

PMID: 15250126

 

Recent articles on tinnitus

Hugh Dominic WStiles25 April 2012

There are some interesting new articles on tinnitus from the April issues of various journals, looking at mechanisms and masking..

The first of the articles below (see PubMed) looks at tinnitus generation. The researchers confirm a relationship between tinnitus pitch and maximum hearing loss, suggesting it is ‘a fill-in-phenomenon resulting from homeostatic mechanisms’.

The second article aimed ‘to define factors that differentially influence subjectively perceived tinnitus loudness and tinnitus-related distress’, and concluded that ‘Subjective tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from tinnitus-related distress’.

The third article looked into a form of tinnitus masking – ‘Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus’.

The fourth article also investigates masking, ‘to reduce tinnitus loudness by exposing chronic tinnitus patients to self-chosen, enjoyable music that was modified (“notched”) to contain no energy in the frequency range surrounding the individual tinnitus frequency and thus attracting lateral inhibition to the brain area generating tinnitus’.

The last article which is quite technical, used animals to model what happens on the ‘brain side’ of the auditory pathway with tinnitus. They say that ‘hyperactivity in the central auditory system is one of the major physiological hallmarks of animal models of noise-induced tinnitus’, and investigated how one part of the system might contribute ‘to hyperactivity at higher levels of the auditory system’.

 

1. Relationship between Audiometric Slope and Tinnitus Pitch in Tinnitus Patients: Insights into the Mechanisms of Tinnitus Generation.
Schecklmann M, Vielsmeier V, Steffens T, Landgrebe M, Langguth B, Kleinjung T.
PLoS One

. 2012;7(4):e34878. Epub 2012 Apr 18.

PMID: 22529949 [PubMed – in process]
Related citations

 

2. Tinnitus: Distinguishing between Subjectively Perceived Loudness and Tinnitus-Related Distress.
Wallhäusser-Franke E, Brade J, Balkenhol T, D’Amelio R, Seegmüller A, Delb W.
PLoS One

. 2012;7(4):e34583. Epub 2012 Apr 18.

PMID: 22529921 [PubMed – in process]
Related citations

 

3. Temporary Suppression of Tinnitus by Modulated Sounds.
Reavis KM, Rothholtz VS, Tang Q, Carroll JA, Djalilian H, Zeng FG.
J Assoc Res Otolaryngol

. 2012 Apr 19. [Epub ahead of print]

PMID: 22526737 [PubMed – as supplied by publisher]
Related citations

 

4. Tinnitus: the dark side of the auditory cortex plasticity.
Pantev C, Okamoto H, Teismann H.
Ann N Y Acad Sci

. 2012 Apr;1252(1):253-8. doi: 10.1111/j.1749-6632.2012.06452.x.

PMID: 22524367 [PubMed – in process]
Related citations

 

5. Noise exposure and auditory effects on preschool personnel.
Sjödin F, Kjellberg A, Knutsson A, Landström U, Lindberg L.
Noise Health

. 2012 Mar-Apr;14(57):72-82.

PMID: 22517307 [PubMed – in process]
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