A. CASE 
OF 
IRRITATION OF THE CHORDA TIMPANI. 
By H D. NOYES, M.D., 
Of New Yoke. 
Reprinted from the Transactions of the American Otological Society. 
BOSTON: 
ALFRED MUDGE & SON, PRINTERS, No. 34 SCHOOL STREET. 
1 8 74. IRRITATION OF CHORDA TYMPANI; PARALYSIS 
OF FACIAL; POLYPOID GROWTH UPON THE 
MEMBRANA TYMPANI; PERIOSTITIS OF THE 
MALLEUS AND ADJACENT BONY TEXTURES. 
Dr. W. E., aged 33, Denver City, Colorada, gives the 
following history, in his own words : — 
" A distressing tinnitus aurinm has troubled me as far back 
as I can remember. 
" When quite a young child I used to lie awake at night and 
complain that the ugly noises would not let me go to sleep. 
At that time I had no suspicion that the sounds were not 
real, and it was only by the observation of later boy- 
hood that I came to realize that they had their origin in a 
disordered condition of the ear itself, and that only the left 
ear was affected. 
" Through my reiterated complaints of noises which had no 
existence, and my constant assertion that I could not keep 
them out by stopping my ears, those having charge of me 
recalled to mind, as a circumstance too trivial to be particu- 
larly noted at the time, that when I was about one year and 
a half old I had an abscess in my left ear, which seemed to 
cause me a great deal of pain, until it broke and discharged 
its contents. After this it was supposed to have healed up 
entirely. Of the exact nature and locality of this abscess I 
have no knowledge. The tinnitus was never absent, was 
different at different times, aud at one time or another it em- 
braced almost every sound within the range of my actual 
experience, and without exception it was made up of sounds 
with whose real counterparts I was perfectly familiar. It 
was always aggravated by violent exercise. 
" A noise like the rumbling of a distant waterfall was the 
HENRY D. NOYES, M. D., NEW YORK. 2 
most constant and the most distressing. Among other noises 
the croaking of frogs, the ringing of bells, and the singing of 
katydids were the most conspicuous. 
" The hearing of the offending ear was seriously impaired, 
and there was unmistakable evidence of perforation of the 
membrana tympani. By closing the external meatus with 
the thumb and exerting sudden pressure, a current of air 
could at any time be driven through the Eustachian tube. 
This current of air imparted a distinctly bitter taste to the 
root of the tongue. The secretion from the walls of the 
meatus was diminished in quantity, and was somewhat 
harder and a good deal darker than normal cerumen, and 
had a slightly fetid odor. 
" This condition of the ear was maintained without material 
change until my twenty-third year. About this time, with- 
out any exciting cause of which I am aware, a thin yellow 
discharge from the meatus began to manifest itself. It was 
only slightly offensive and not very profuse in quantity, but 
was very persistent. Syringing the ear with warm water or 
astringent solutions seemed not to affect it in the least. 
Several times since then the discharge has spontaneously 
ceased, sometimes for months at a time ; but sooner or later 
it has always returned. Its cessation was never followed by 
any inconvenience. Soon after it was first established, there 
supervened an occlusion of the opening which had hereto- 
fore existed in the membrana tympani, and I have never 
since been sensible of the passage of air through this mem- 
brane. 
"A sensation very difficult to describe, now for the first 
time began to give me serious annoyance. It was a sensa- 
tion of weight, of pressure, of obstruction, and of distension, 
and affected the entire left side of my head. It came at first 
in paroxysms of uncertain length, and at irregular periods, 
but soon became constant. I finally grew in some degree ac- 
customed to it and was less disturbed by it than when I first 
felt it. Not long after this very unpleasant symptom was 
first observed, the chorda tympani nerve began to manifest symptoms of being in a state of irritation. I one day 
noticed that on pressing the tip of the finger rather forcibly 
into the opening of the auditory canal, the gustatory nerve 
of the left side of the tongue was quite sensibly affected. 
Soon afterward I noticed that a sharp pinch given to any 
part of the pinna, between the thumb and finger, induced the 
same resqlt. Within two or three weeks after this peculiar 
irritation of the tongue first manifested itself, it could be 
excited at any moment by merely passing the tip of the fin- 
ger over the left side of the face. It continued to be more 
and more easily induced, until finally, within two or three 
months after its first advent, it became constant, without any 
external exciting cause. Since then it has never been wholly 
absent, and the means which first called it forth, to wit, 
pinching the pinna, etc., at any time intensifies it. 
" An increased flow of saliva into the left side of my mouth 
has always been in direct proportion to the amount of this 
peculiar irritation present. The larger portion of this saliva 
comes through Wharton’s duct, but the left parotid gland 
also secretes more abundantly than the right. 
" Paralysis of the facial nerves finally supervened quite sud- 
denly about the first of last February, nearly ten years 
after the stoppage of the opening in the ear-drum. During 
all this period the tinnitus aurium had been in no degree 
arrested, having maintained throughout its original charac- 
teristics. 
"For several months preceding the paralysis there was slight 
but very frequent twitchings of all the muscles supplied by 
the facial nerve. Rarely more than one muscle was affected 
at one time. 
"It was during an attack of acute inflammation of the audi- 
tory canal that I laid down one morning to take a nap. I 
attributed this inflammatory attack to undue exposure. The 
walls of the meatus were hot, tender to the touch, and 
quite painful, but there was no deep-seated pain. When I 
awoke, after sleeping about two hours, the paralysis had 
taken place.” 
My inspection of the case showed complete paralysis of 4 
the left side of the face, including the forehead and orbicu- 
laris oculi; the mouth, which is large, drawn to the opposite 
side; the tongue, when protruded, came out perfectly 
straight, and could be moved at will to either side; the 
meatus auditorius large and straight; the drum-head nearly 
flat, tense, white, and thick, not vascular. Seated upon its 
upper and middle portion was a polypoid growth as large 
as a small pea. It was firm to the touch, and though red, 
not disposed to bleed. The slightest touch of it, though not 
painful, excited sensations in the tongue. A moderate quan- 
tity of pus was found in the canal, but the walls were not 
sensitive to touch. The Eustachian tube pervious; the 
cavitas tympaui easily inflatable. Hearing distance for the 
watch requires contact. 
To destroy the polypus the galvano-caustic was employed. 
Its use was severely painful, but not succeeded by great 
reaction. A rather copious discharge ensued, the sense of 
pressure in the bead was much abated, and the tumor grew 
smaller. A succession of less severe cauterizations by nitric 
acid were afterwards employed, and finally what remained 
of the growth wjis deeply incised by a needle and treated by 
nitric acid. After this it disappeared, and the drum-head 
exhibited no irregularity of surface. It seemed evident, then, 
that there was no similar granulation tissue in the middle 
ear. There was no perforation of the membrana tympani. 
The polypus sprang from the manubrium of the malleus, 
and a fair inference seems to be, that this bone had been the 
seat of chronic inflammation, involving its substance and peri- 
osteum, and which had caused the irritation of the chorda tym- 
pani. This must have existed since a very early period of 
the disease, and a more than ordinary amount of congestion 
must have existed in the bony tissues to have produced the 
cerebral symptoms, and finally the paralysis of the facial 
nerve. The employment of the galvano-caustic upon the 
polypus gave great relief to the heavy and oppressive sensa- 
tions about the head, and the patient on returning home was 
quite free from this annoyance. The discharge from the ear 
disappeared. The hearing distance increased from watch con- 5 
tact to watch at six inches. The paralysis of the facial nerve 
exhibited no improvement. The irritability of the chorda 
tympani was not completely relieved, but greatly abated. 
In this connection, I introduce the notes furnished by Dr. J. 
J. Mason, who was kind enough to take charge of the elec- 
trical treatment of the case. 
"No response obtained by strong faradic currents, and as 
there seems to be an idiosyncracy, consisting in excessive 
sensitiveness to the Voltaic current, no satisfactory test 
of its action can be obtained. Closing and opening five 
cells causes considerable vertigo, with no trace of contrac- 
tion. Ten cells were tried, with no more effect on the mus- 
cles, but with great aggravation of vertigo. Very rapid in- 
terruption by clock-work was tried, with the effect of reducing 
vertigo, but of course diminishing the specific action of the 
current. The patient notices a sensation of taste referred to 
left chorda tympani, whenever he makes an effort to move 
the paralyzed side. 
'* The treatment has been continued (three times a week) 
up to date, and has consisted of mild faradic currents to the 
affected muscles. No improvement either in voluntary or 
electric ' contractility.’ ” 
JOHN J. MASON. 
New York, May 15, 1874. 
The hyperaesthesia seems to be limited to the affected side, 
and only reveals itself to electric irritation. 
Cases of persistent irritation of the chorda tympani are 
not often recorded, and the facts of this case possess both a 
clinical and physiological value. In the latter sense no 
new facts are shown, but the results of experiments upon 
animals are confirmed. It appears that the nerve has no con- 
trol over muscles of the tongue, but simply excites sensa- 
tions of pain and of taste, which are perceived chiefly at the 
side and upon the back of the tongue. It also in a marked 
degree provokes secretion from the sub-maxillary gland, and 
in a less amount from the parotid. 
These are precisely the facts which have been elicited in 
experiments upon the lower animals.