For Tinnitus Awareness week, here is a selection of review articles published in the last year.  a review article is an analysis of research articles, so can provide a useful overview.  Follow the links for abstracts where available, and note that several articles are open access.

 

Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JW, Hoare DJ.
Cognitive behavioural therapy for tinnitus.
Cochrane Database Syst Rev. 2020 Jan 8;1:CD012614. doi: 10.1002/14651858.CD012614.pub2.

 

Azevedo AA, Figueiredo RR, Penido NO.
Tinnitus and event related potentials: a systematic review.
Braz J Otorhinolaryngol. 2020 Jan – Feb;86(1):119-126. doi: 10.1016/j.bjorl.2019.09.005. Epub 2019 Nov 4. Free Article

 

Nagaraj MK, Prabhu P.
Internet/smartphone-based applications for the treatment of tinnitus: a systematic review.
Eur Arch Otorhinolaryngol. 2019 Dec 5. doi: 10.1007/s00405-019-05743-8.

 

Jafari Z, Kolb BE, Mohajerani MH.
Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes.
Ageing Res Rev. 2019 Dec;56:100963. doi: 10.1016/j.arr.2019.100963. Epub 2019 Sep 23.

 

Shore SE, Wu C.
Mechanisms of Noise-Induced Tinnitus: Insights from Cellular Studies.
Neuron. 2019 Jul 3;103(1):8-20. doi: 10.1016/j.neuron.2019.05.008.

 

Smith H, Fackrell K, Kennedy V, Barry J, Partridge L, Hoare DJ.
A scoping review to catalogue tinnitus problems in children.
Int J Pediatr Otorhinolaryngol. 2019 Jul;122:141-151. doi: 10.1016/j.ijporl.2019.04.006. Epub 2019 Apr 11. Free Article

 

Hullfish J, Sedley W, Vanneste S.
Prediction and perception: Insights for (and from) tinnitus.
Neurosci Biobehav Rev. 2019 Jul;102:1-12. doi: 10.1016/j.neubiorev.2019.04.008. Epub 2019 Apr 15.

 

Schwippel T, Schroeder PA, Fallgatter AJ, Plewnia C.
Clinical review: The therapeutic use of theta-burst stimulation in mental disorders and tinnitus.
Prog Neuropsychopharmacol Biol Psychiatry. 2019 Jun 8;92:285-300. doi: 10.1016/j.pnpbp.2019.01.014. Epub 2019 Jan 29.

 

Sedley W.
Tinnitus: Does Gain Explain?
Neuroscience. 2019 May 21;407:213-228. doi: 10.1016/j.neuroscience.2019.01.027. Epub 2019 Jan 26. Free Article

 

Theodoroff SM, Saunders GH.
Key Findings From Tinnitus Research and Clinical Implications.
Am J Audiol. 2019 Apr 22;28(1S):239-240. doi: 10.1044/2019_AJA-TTR17-19-0016. Free Article

 

Tzounopoulos T, Balaban C, Zitelli L, Palmer C.
Towards a Mechanistic-Driven Precision Medicine Approach for Tinnitus.
J Assoc Res Otolaryngol. 2019 Apr;20(2):115-131. doi: 10.1007/s10162-018-00709-9.

 

Zheng Y, Smith PF.
Cannabinoid drugs: will they relieve or exacerbate tinnitus?
Curr Opin Neurol. 2019 Feb;32(1):131-136. doi: 10.1097/WCO.0000000000000631.

 

Tang D, Li H, Chen L.
Advances in Understanding, Diagnosis, and Treatment of Tinnitus.
Adv Exp Med Biol. 2019;1130:109-128. doi: 10.1007/978-981-13-6123-4_7.

 

Valentino WL, McKinnon BJ.
What is the evidence for cannabis use in otolaryngology?: A narrative review.
Am J Otolaryngol. 2019 Sep – Oct;40(5):770-775. doi: 10.1016/j.amjoto.2019.05.025.

 

Salehi PP, Kasle D, Torabi SJ, Michaelides E, Hildrew DM.
The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review.
Am J Otolaryngol. 2019 Jul – Aug;40(4):594-597. doi: 10.1016/j.amjoto.2019.03.017.

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 1^st 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

Maria Konstantinovna Bashkirtseva or Marie Bashkirtseff (1858-1884), was a Ukrainian Russian born artist and diarist.  She led a fascinating if brief life, and kept a regular diary from the age of twelve, where she put everything of herself, her hopes, fears, sorrows and joys.  Gladstone famously called it “a book without a parallell.”

The diaries were originally published by her family in an expurgated version in 1888, which was translated into English by the German born English poet, Mathilde Blind.  Marie describes her life, struggles to be accepted in art, and her illness, of which her hearing loss and deafness was a side effect.  More details of her life are to be found on the web (see links below) and her portrait paintings are very fine, well worth seeking out.  She attended the same Art School in Paris as the British Deaf art student George Annand Mackenzie did some years later, the Académie Julian.

Her experience of losing her hearing will, I believe, be recognized by many in a similar situation.  The follow entries date from 1880.  At first there is the mishearing –

Saturday, May 8th. — When people talk in a low voice I do not near. This morning when Tony asked me whether I had seen any of Pemgino’s work, I said “No,” without understanding.

And when I was told of it afterwards, I got out of it, but very badly, by saying that indeed I had not seen any of it, and that, on the whole, it was better to admit one’s ignorance. (p.406)

Then she has tinnitus, and has to endure the ignorant behaviour of others –

Thursday, May 13th. — I have such a singing in my ears that I am obliged to make great efforts in order that it may not be noticed.

Oh ! it is horrible. With S___ it is not so bad because I am sitting near him ; and besides, whenever I like, I can tell him that he bores me.  The G___s talk loud. At the studio they laugh and tell me that I have become deaf; I look pensive, and I laugh at myself: but it’s horrible. (p.407)

There are times when it improves –

Wednesday, July 21st. — I have commenced my treatment. You are fetched in a closed Sedan chair. A costume of white flannel — drawers and stockings in one — and a hood and cloak ! Then follow a bath, a douche, drinking the waters, and inhaling in succession. I accept everything. This is the last time that I mean to take care of myself, and I shouldn’t do it now but for the fear of becoming deaf. My deafness is much better — nearly gone. (p.416)

Then she is told how serious her condition is –

Friday, September 10th. — … Doctor Fauvel, who sounded me a week ago and found nothing the matter, has sounded me to-day and found that my bronchial tubes are attacked ; his look became . . .  grave, affected, and a little confused at not having foreseen the seriousness of the evil ; then followed some of the prescriptions for consumptive persons, cod-liver oil, painting with iodine, hot milk, flannel, &c. &c, and at last he advises going to see Dr. Sée or Dr. Potain, or else to bring them to his house for a consultation. You may imagine what my aunt’s face was like ! I am simply amused ! I have suspected something for a long time ; I have been coughing all the winter, and I cough and choke still.

Besides, the wonder would be if I had nothing the matter ; I should be satisfied to have something serious and be done with it

My aunt is dismayed, and I am triumphant Death does not frighten me; I should not dare to kill myself but I should like to be done with it . . . If you only knew ! . . . . I will not wear flannel nor stain myself with iodine; I am not anxious to get better. I shall have, without that, quite enough health and life for all I shall be able to do in it.

Friday, September 17th. — Yesterday I went again to the doctor to whom I went about my ears, and he admitted that he did not expect to see matters so serious, and that I should never hear so well as formerly. I felt as if struck dead. It is horrible! I am not deaf certainly, but I hear as one sees through a thin veil. For instance, I cannot hear the tick of my alarm-clock, and I may perhaps never hear it again without going close up to it. It is indeed a misfortune. Sometimes in conversation many things escape my hearing. . . . Well, let us thank heaven for not being blind or dumb as yet. (p.422-3)

This was two years before Robert Koch, the founder of modern microbiology, identified the causative agent of ‘consumption’ – Tuberculosis, as Mycobacterium tuberculosis.  It seems likely that the this was the cause of her deafness, but we cannot be sure.  In that year, 1882, she was confronted by the news that her hearing was gone and would not return –

Thursday, November 16th. — I have been to a great doctor — a hospital surgeon — incognito and quietly dressed, so that he might not deceive me.

Oh! he is not an amiable man. He has told me very simply I shall never be cured. But my condition may improve in a satisfactory manner, so that it will be a bearable deafness ; it is so already ; it will be more so according to all appearances. But if I do not rigorously follow the treatment he prescribes it will increase. He also directs me to a little doctor who will watch over me for two months, for he has not the time himself to see me twice a week as is necessary.

I have had for the first time the courage to say, “Monsieur, I am growing deaf.” Hitherto I have made use of, ” I do not hear well, my ears are stopped, &c.” This time I dared to say that dreadful thing, and the doctor answered me with the brutality of a surgeon.

I hope that the misfortunes announced by my dreams may be that But let us not busy ourselves in advance with the troubles which God holds in reserve for his humble servant. Just at present I am only half deaf.

However, he says that it will certainly get better. As long as I have my family to watch round me and to come to my assistance with the readiness of affection all goes well, yet …. but alone, in the midst of strangers !

And supposing I have a wicked or indelicate husband ! … If again it had been compensated by some great happiness with which I should have been crowned without deserving it ! But . . . why, then, is it said that God is good, that God is just ?

Why does God cause suffering? If it is He who has created the world, why has He created evil, suffering, and wickedness ?

So then I shall never be cured. It will be bearable ; but there will be a veil betwixt me and the rest of the world. The wind in the branches, the murmur of the water, the rain which falls on the windows . . . words uttered in a low tone … I shall hear nothing of all that ! With the K____ s I did not find myself at fault once ; nor at dinner either ; directly the conversation is just a little animated I have no reason to complain. But at the theatre I do not hear the actors completely ; and with models, in the deep silence, one does not speak loud . . . However . . . without doubt, it had been to a certain decree foreseen. I ought to have become accustomed to it during the last year … I am accustomed to it, but it is terrible all the same.

I am struck in what was the most necessary to me and the most precious. (p.565-6)

She died on October the 31st, 1884, and was buried in the Cimetiere de Passy in Paris, a few weeks before her twenty-sixth birthday.

It is certainly wrong to portray her by her illness alone.  She was a dynamic and interesting person, and the tragedy is she did not have the opportunity to show what she might have achieved.  I hope some of you will be interested to read her diaries and see her paintings.

Journal of Marie Bashkirtseff, Translated by Mathilde Blind, London 1890

https://www.britannica.com/biography/Marie-Bashkirtseff

http://www.gutenberg.org/files/13916/13916-h/13916-h.htm

https://mydailyartdisplay.wordpress.com/2015/02/23/marie-bashkirtseff-part-2-her-later-life-and-diaries/

http://en.wikipedia.org/wiki/Marie_Bashkirtseff

https://mydailyartdisplay.wordpress.com/2015/02/14/marie-bashkirtseff-part-1-the-portraitist-and-feminist/

Gladstone, W. E. (1889). JOURNAL DE MARIE BASHKIRTSEFF. The Nineteenth Century: A Monthly Review, Mar.1877-Dec.1900, 26(152), 602-607. Retrieved from https://search.proquest.com/docview/2630378?accountid=14511

Her paintings:

https://www.wikiart.org/en/marie-bashkirtseff/all-works#!#filterName:all-paintings-chronologically,resultType:masonry

https://www.ecosia.org/images?q=marie+bashkirtseff

The following looks interesting but I have not seen the article:

 

Lincolnshire born Joseph Toynbee (1815-66) was a pioneer otologist.  He attended school in King’s Lynn, then was apprenticed to William Wade of the Westminster General Dispensary, and later on at St George’s and University College Hospitals (Weir).  In 1842 he became a Fellow of the Royal Society, surely one of the youngest fellows, for “his researches demonstrating that articular cartilage, the cornea, the crystalline lens, the vitreous humour, and the epidermal appendages contained no blood-vessels” (Plarr’s Lives of the Fellows).  He was early on an opponent of the ‘aurists’ like John Harrison Curtis, writing letters to The Lancet on the matter. Curtis claimed that some deafness came “from a want of action of the ceruminous glands” – that is a lack of wax.

Toynbee belongs to the great set of scientists, like John Scott Haldane, who tried self-experimentation. In the case of Toynbee this did not end well. The Leeds Mercury begins its story on Toynbee’s end as follows:

Lamentable Death of a Medical Man
Yesterday afternoon a very painful investigation took place before Mr. C. St. Clare Bedford and a select jury at the New Vestry-hall, St. James’s, Piccadilly […] which was caused by the inhalation of chloroform and cyanic acid while prosecuting experiments for the advancement of science. […]
He was continually in the habit of making experiments on himself for scientific purposes and for the relief of suffering mankind (The Leeds Mercury).

His man-servant George Power described how he saw a patient in the afternoon for a few minutes. Shortly after another patient called & Power entered the room to find Toynbee lying with a piece of cotton wool over his nose and mouth. He thought he was asleep but removing the cotton wool realised that something was wrong then ran off down Savile Row trying to get another doctor to assist, to no avail. In the meantime Dr. Orlando Markham, a colleague from St. Mary’s hospital, had heard that Toynbee was in need of help, but arrived to find him dead. With another friend, Dr. Arthur Leared, they tried artificial respiration for half an hour. It seems from papers and a watch on his chairs, that he was trying “The effect of inhalation of the vapour of chloroform for singing in the ears so as to be forced to the tynpanum, either by being taken in by the breath through a towel or a sponge, producing a beneficial sensation or warmth”,  and “The effect of chloroform combined with hydrocyanic acid”.  He died on the 7th of July 1866, either from the chloroform, or the combination (The Morning Post, Leeds Mercury).  

We have a copy of Toynbee’s A Descriptive Catalogue of Preparations Illustrative of the Diseases of the Ear in the Museum of Joseph Toynbee that must have been given by Toynbee as it is signed ‘from the author’, to Henry Hancock the surgeon, like Toynbee one of the original 300 fellows of the Royal College of Surgeons.  He was not an ENT specialist, so perhaps that is why he then donated the book to the Charing Cross Hospital with which he had a long association.  The Catalogue describes items in Toynbee’s collection, which ended up in the Hunterian but was lost during the war in an air raid.  A page here shows that foreign bodies in ears are not new!

In the introduction he writes,

When, in the year 1839, I entered upon a systematic study of the diseases of the ear, the conviction was soon forced upon me, that its pathology had been almost entirely neglected. This conviction induced me to commence a series of dissections of that organ, which have continued up to the present time, and now amount to 1,659.

Above is a page from his book  The diseases of the ear: their nature, diagnosis, and treatment (1868) which demonstrates use of a eustachian catheter.

An experiment in chloroform (from the website of our friend)  Dr. Jaipreet Virdi-Dhesi, From the Hands of Quacks

Curtis J.H., Employment of creosote in deafness. Lancet 1838, 31 328-30

The Leeds Mercury (Leeds, England), Thursday, July 12, 1866; Issue 8813. British Library Newspapers, Part I: 1800-1900

The Morning Post (London, England), Wednesday, July 11, 1866; pg. 3; Issue 28886. British Library Newspapers, Part II: 1800-1900

Mudry A., The making of a career: Joseph Toynbee‘s first steps in otology. J Laryngol Otol. 2012 Jan;126(1):2-7. doi: 10.1017/S0022215111002465. Epub 2011 Sep 5.

Neil Weir, ‘Toynbee, Joseph (1815–1866)’, Oxford Dictionary of National Biography, Oxford University Press, 2004 [http://www.oxforddnb.com/view/article/27647, accessed 12 Aug 2016]