THE VALUE OF NITROGLYCERINE IN TINNITUS AURIUM. 
VALE UK DE LA NITRO-GLYCERINE DANS LE BOUR- 
DONNEMENT DES OREILLES. 
DEIt WERTH RES NITROGLYCERINS BE! OHRENSAUSEN. 
READ IN THE SECTION OF OTOLOGY, INTERNATIONAL MEDICAL 
CONGRESS, NINTH SESSION. 
By LOUIS J. LAUTENBACH, A. M., M. D., Ph. D., 
PHILADELPHIA, 
SURGEON TO THE PENNSYLVANIA EYE AND EAR INFIRMARY ; 
CHIEF OF THE EYE CLINIC OF THE GERMAN HOSPITAL, ETC. 
After the usual experience in ear-work, and a grad- 
ual accumulation of unimproving cases of tinnitus 
auriutn, I began to study the general effects of nitro- 
glycerine, and to use it in these cases. It had been 
used by others in tinnitus, both with and without suc- 
cess, but I knew of no way of recognizing the cases in 
which it would be most likely to prove serviceable. 
In order to learn when to use it, I began to give it, in 
private practice, to all cases of tinnitus in which I had 
found no improvement under other treatment, and, in 
public practice, in all cases of tinnitus. In some cases 
there was improvement, in others there was none. 2 
NITROGLYCKKINK IN TINNITt’S At’KIl’M. 
In the patients where improvement had occurred 
there was found to be present a similarity of condi- 
tions, and I soon satisfied myself that there was a class 
of patients in which the nitroglycerine treatment was 
valuable. I found it most serviceable in patients hav- 
ing tinnitus auriutn, without much impairment of 
hearing, and where but little change had occurred in 
the naso pharynx, and where it was found, on examin- 
ation, that some abnormal condition of the heart 
existed, either functional or organic. 
In many of these cases more or less structural 
changes, from catarrhal inflammation of the middle ear, 
were present, among them changes in the shaj>e and 
translucency of the drumhead, with accompanying 
change in appearance or position of the triangular light 
spot. Follicular pharyngitis was present in some of 
the cases. The tinnitus was generally constant, or 
nearly so. It was not. as a rule, more marked when 
the patient was in a recumlient position; occasionally 
there was some remission in that position. The ther 
mometric and barometric conditions of the atmosphere 
influenced the tinnitus. Damp weather, with low 
l»arometer. usually increased it. 
Dull, heavy headache, more or less persistent, and 
most frequently located in the parietal regions, though 
sometimes located in the frontal region, was of frequent 
occurrence. 
In these cases I used the nitroglycerine in pill form, 
and in doses of one hundredth of a grain. At first but 
one pill a day was given, generally in the morning. 
The amount given later was increased, enough of the 
pills l>eing given to diminish the tinnitus, or to cause NITROGLYCERINE IN TINNITUS AURIUM. 
3 
headache. As many as six of these pills were given 
in a day, though usually two were found to produce a 
beneficial effect. Improvement sometimes was mani- 
fest within a day or two after beginning the use of the 
remedy. In cases of long standing the remedy was 
sometimes continued for a period varying from one to 
three months before a satisfactory result was obtained. 
Cases, in which there was recurrence of the tinnitus, 
seemed to yield more readily on resuming the treat- 
ment than when the remedy was first administered. 
The conclusion which I reached, after a fair trial of 
this remedy, was, that it is of value in certain cases of 
tinnitus aurium, especially in those where cardiac lesion 
exists, functional or organic, and where there is little 
or no loss of hearing. 
1723 Walnut Street, Phila.