Biomedical subjects
Publications and source records attributed to M Hülse.
A case--report is given of a patient with Cogan's syndrome in childhood. This syndrome consists of non-syphilitic interstitial keratitis and vestibuloauditory symptoms. Visual loss is rare but hearing loss is rapidly progressive. A relation to autoimmune diseases especially to panarteriitis nodosa has been suggested by a number of authors.
A method for objective measurements of the sound attenuation provided by ear protectors is described, utilizing a head model which contains all normal human sound properties. The difficulties experienced in localizing sound sources when wearing ear protectors is explained by changing the characteristics of the individual frequency bands.
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Two patients with absent peripheral labyrinthine function are reported, in whome cervical nystagmus could be demonstrated. Return of labyrinthine function with simultaneous disappearance of the cervical nystagmus in one of the patients demonstrates existence of receptors in the upper three vertebral joints and their potential influence on the vestibular system. Pathogenetic as well as diagnostic functions of the sensory afferent systems of the upper cervical region are discussed.
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An organic phosphate insecticide poisoning is described, and the otologic findings elaborated. Disturbances of equilibrium were observed through a four-month period and documented by electronystagmography. Although damage of the central vestibular system was found, subjective complaints by the patient resolved completely within four months of the poisoning. However, thereafter both positional nystagmus and nystagmus after passive movements of the head could be observed. During the entire study period, neither hearing loss nor tinnitus occurred. After a review of the literature, the disturbances of equilibrium were designated as a sequela of the organic phosphate insecticide poisoning.
The acute cervical vertigo with the single symptome of rotary vertigo is most probably caused by a functional disturbance in the upper third of the cervical spine. Distinct patho-anatomical changes could not be observed. The findings on the cervical spine are based on an osteopathic examination. The therapy of choice is a manipulation. Three cases are reported.
A Treacher Collins-syndrome has been followed up in a family over 3 generations. We found a change in deafness from grand parents- and parents-generation to the third one. The first two showed an inner ear deafness, the latter the well-known conduction deafness. The phenotype becomes more and more extensive in the following generations. Simultaneous with this development the deafness becomes more typical. In theory the inner ear deafness could either be explained as the final stage of a long standing conductive deafness or it is part of an incomplete developed syndrome.
Reffering to 92 expert evidences on the noise-deafness the signs are shown, in which the mining noise-deafness differs from the typical noise deafness in the metallurgical industry. In more than 80% of the cases a slope of the curve could be observed in the audiogram beginning at 125 cps. Therefore the hearing loss early impairs the ability to understand conversational speech. Only every second patient shows a positive result at the SISI-test; this is the reason, that the mining noise deafness frequently is misinterpreted. In these cases the cochlear hearing loss will be surely proved by the Langenbeck-audiogram and Békésy-audiogram. A secondary finding was the typical "mining ear-drum". These ear drums are bilaterally whitish, without reflex and thickened; they don't show any air-bone gap in the audiogram. The differences between the mining noise-deafness and the typical noise-induced hearing loss are explained by an additional baro-trauma which occurs, when the pitmans work at a depth of about 2000 feet.
Exactly 30 years ago D. C. Cogan reported 4 cases of "nonsyphilitic interstitial keratitis associated with vestibulo-auditory symptoms". Report of 57 of these cases have come to our attention. They mostly concern relatively young people, although the age range is now 4-1/2 to 63 years. The etiology of Cogan's syndrome is unknown. It very frequently has been associated with some generalized vascular diseases. In our first case, a 13 year old boy, we found the symptoms of a serous meningitis with pathological signs in the EEG. No vascular changes were encountered. During 4 weeks the rapidly progressive hearing loss was accompanied by tinnitus and vertigo and an interstitial keratitis. The recession of vestibular symptoms is followed by the loss of function of the endorgans. The voice seemed high-pitched and monotonous. In our patient the eye condition improved, but the cochleo-vestibular disturbances did not. The second case, a 27 year old woman, could be observed over a period of 19 years. The ocular symptoms disappeared nearly completely after 1 year, but the cochleo-vestibular disturbances remained. The audition shows even after 19 years some fluctuations.
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Explore the source record for details and available documents.
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