NASAL OBSTRUCTION AS A FACTOR 
OF TINNITUS A URIUM. 
BY FRANCIS J. QUINLAN, M.D., 
Adjunct Professor of Diseases of the Nose and Throat, New 
York Polyclinic; Assistant Surgeon New York Eye 
and Ear Infirmary, Ear Department, Etc., Etc. 
There is probably no symptom so re- 
bellious to treatment, or so discouraging to 
patients, as Tinnitus Aurium. It is more 
apparent in middle life and old age, but 
manifests itself in youth as well. An at- 
mosphere of mystery surrounds its cause, 
at times calling forth many and various 
forms of medication. The complications of 
nasal obstruction, one of the many lesions, 
will occupy our attention in this brief 
paper, and in discussing the subject, the 
endeavor will be made to adhere closely to 
facts, and to cite only well-known author- 
ities in support of the contention advanced. 
The variety and character of noises interest 
us but little, except for the belief that the 
nature and character of the tinnitus serve to 
Reprinted from the New York Polyclinic, June, 1895. 2 
localize the lesion. We do know that these 
noises have pursued their victims with the 
fierceness of a bloodhound, and that the 
wards of asylums and the graves of sui- 
cides bear testimony to their incessant and 
relentless torture. It is not intended to 
disregard the many remedies which have 
been so successfully applied, but to enter 
an earnest plea for a more thorough in- 
spection of the upper air-chambers. 
A brief glance at the vascular supply of 
the internal and middle ear, will reveal the 
rich and free anastomosis that takes place 
between it and the tissues of the nose and 
throat. Zucherland, in writing on this sub- 
ject, points out the close connection be- 
tween the cavernous sinuses and the tur- 
binal bodies, and his statement concerning 
this intimate relation is quoted by Dench 
with approval. A similar, and even greater 
affinity, is noted in the lymphatics. The 
nervous supply of these parts again very 
forcibly demonstrates their close connection 
by rich and free anastomosis, which gives 
rise to many reflex disturbances. (Vide 
Dench, "Diseases of the Ear," pp. 31 and 
32.) 
French, of Brooklyn, in his admirable 3 
treatise on "Lymphoid Tissues in the 
Vault," cites instances of headache, chorea, 
convulsions, asthma, and epistaxis, depend- 
ant upon nasal stenosis, which seem easy 
of explanation upon considering the fore- 
going arrangements of the structures and 
tissues of the middle ear. This arrange- 
ment shows how deafness and tinnitus are 
occasioned by their proximity. 
Lennox Browne, in his recent work on 
throat and nose, gives us the following 
figures : Out of 4936 persons afflicted with 
nose and throat affections, ear complica- 
tions occurred in 1890. Dr. Buck, in his 
"Treatise on the Ear," goes still further in 
the closing sentence of the chapter on the 
treatment of diseases of the middle ear. 
He states : "It is an important co-operating 
faction, and permanent relief can scarcely 
be obtained in cases for any length of time, 
as long as the nasal obstruction is allowed 
to remain." Authorities acknowledge that 
most patients with diseases of the middle 
ear have been the victims of repeated colds, 
and that these rhinal and pharyngeal in- 
flammations diminish the calibre of the 
eustachian tubes, exhaust the air in the tym- 
panic cavity, and unless corrected, cause 4 
lesions of the labyrinth, giving rise to tin- 
nitus and even deafness itself. 
The following cases, occurring within 
the practice of the writer, are typical dem- 
onstrations of the permanent relief afforded 
by operative measures upon the upper air 
tract: 
Laura F.; age, sixteen ; tall, pale ; mother 
in good health ; father died of phthisis. 
Patient has been complaining of ringing in 
the left ear for five years; at times so 
severe that the mother feared mental 
trouble. The condition was much worse in 
damp weather. She was assured that the 
girl would outgrow it. 
The writer first saw the patient while she 
was suffering from a severe attack of fol- 
licular pharyngitis. The mother casually 
mentioned the co-existence of the tinnitus. 
Examination of the nares disclosed a ridge 
of septal tissue, filling up the right side, and 
burying itself in the soft mucous membrane 
of the turbinal opposite. The offending 
tissue was removed, slight hemorrhage fol- 
lowed the operation, and within ten days 
the patient experienced a remarkable sense 
of relief. Five months after the operation, 
there was no return of the tinnitus, and a 
general improvement in the patient's con- 
dition was apparent. 
In a paper read at the Academy of Med- 
icine four years ago, the writer narrated the 
case of a boy, who for eleven years had a 5 
converging squint, that was corrected by an 
operation upon the nasal septum. It is 
needless to add that many lesions, such as 
chorea, facial neuralgia, epilepsy and tin- 
nitus, have been greatly aggravated, if not 
directly caused, by irregularities of the car- 
tilaginous and bony septum. 
Joseph M., aged twenty ; poorly nour- 
ished ; never had been in good health ; gave 
a history of ringing in both ears and of re- 
peated colds in the head ; had an attack of 
diphtheria eight years ago. Inspection of 
the fauces showed two large, fibroid tonsils, 
almost approximating the median line. 
After removing the tonsils, a large mass of 
lymphoid tissue was found filling up the 
rhinal pharynx, and pressing upon both 
eustachian tubes. Three sittings were re- 
quired to remove the mass, and rapid im- 
provement followed. A letter received six 
weeks ago from the young man, one year 
after the operation, states that there has 
been no return of the tinnitus. 
Dr. Quaiffe describes, with great detail, 
the relief afforded in cases of tinnitus and 
impaired hearing, after operations for the 
removal of hyperthropied tonsils and ade- 
noids. Meyer, of Copenhagen, says that in 
102 cases of adenoids, 72 suffered from dis- 
eases of the ear. Swinburne goes further, 
by telling us that "in 42 cases of lymphoid 
hypertrophy of the vault, 27 had complica- 
tions of the middle ear. This percentage 6 
included all ages." Lennox Browne main- 
tains that "deafness, facial and thoracic de- 
formity, as well as faulty articulation, may, 
in the meanwhile, become irremediably 
established." 
Bernard L., aged fifty-two, married, 
printer, uses stimulants and tobacco ; has 
had roaring noises in both ears since 1865 ; 
no specific history. The patient has con- 
sulted physicians in the last ten years, but, 
according to his story, medication alone 
was directed to the ears. For the past three 
years the patient has been so depressed and 
absent-minded that he could not attend to 
his business. Examination of the nostrils 
showed almost a complete stenosis of both 
sides. The mucous membrane was hyper- 
trophied from the vestibule to the posterior 
nares. The noises suddenly ceased upon 
the introduction of pledgets of cotton, sat- 
urated with a ten per cent, solution of 
cocaine. The hypertrophies were removed 
with the cold snare, and since the last ope- 
ration the patient has experienced entire 
relief. Bosworth, in his recent edition of 
" The Nose and Throat," remarks : "In a 
certain proportion of cases of hypertrophic 
rhinitis, tinnitus is met with usually in 
middle ear diseases, although in a small 
proportion of cases, there is apparently, no 
organic lesion. That this distressing symp- 
tom may be dependent on nasal disease, is 
shown by the fact that in a flattering pro- 7 
portion of cases it disappears under treat- 
ment." Lennox Browne, again alluding to 
this symptom, remarks that "hypertrophic 
catarrh is often associated with tinnitus, 
vertigo, and even intra-cranial suppuration." 
Mary G., aged thirty-nine, married, 
mother of five children ; voice husky ; has 
been a victim of asthma since girlhood, and 
has complained for the last eleven years of 
a singing in both ears, aggravated especially 
in the evenings of damp seasons. The 
patient had taken the orthodox remedies for 
the relief of her symptoms, which yielded 
but little up to this time. The nose was 
found to contain a mass of mucous polyps, 
filling both cavities, and extending into the 
rhino-pharynx. No operation had ever been 
suggested. The patient was, therefore, un- 
willing to submit to one. Finally she con- 
sented, and the growths were removed. In 
consequence of frequent paroxysms of dys- 
pnoea, the operations were often delayed, 
but ultimately the nasal cavities were 
cleared, and the condition of our patient 
greatly improved. It is now fourteen 
months since any surgical interference has 
taken place, and up to the present writing 
there has been no recurrence of the tin- 
nitus. The asthmatic attacks have become 
less frequent, much shorter, and less 
severe. Robinson boldly states, that "tin- 
nitus aurium frequently occurs as a compli- 
cation of nasal polypus." We are all aware 8 
of the results of any interference with 
proper respiration." 
Dr. Bosworth's forcible statement adds 
weight to the conclusions of the writer, 
when he emphasizes the following: 
" A result of interference with normal 
respiration, rarification of air, gives rise to 
a condition of hyperaemia of the mucous 
membrane of the eustachian tubes, and 
rhiddle ear ; this eustachian orifice is closed, 
the air in the middle chamber rarified, the 
drum head retracted, and further changes in 
connection with the more intricate appa- 
ratus of the ear, result in its impairment. 
In a very large number of cases this pro- 
cess continues to lead to ankylosis of the 
ossicles, and atrophy of the tympanic mem- 
brane." This statement, coming from the 
pen of such an authority, must certainly 
add weight to our argument, and enlighten 
our interrogations in so important a subject 
as that under consideration. 
The conclusion naturally arrived at in 
reviewing the foregoing cases of nasal 
stenosis is this : That whether we attempt 
to locate lesions in the external auditory 
canal, the middle ear, or even the labyrinth 
itself, it is our duty to make a thorough and 
complete examination of the nostrils, and 
their accessory cavities, and to remove all 
offending tissues that serve to interfere with 
the proper respiratory functions of the 
nose.