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The uncertainty further increased the declaration, that the sound-conducting power the bones of the head lessened with age, and also a thick diploe, a thick scalp and soft parts that fmaHy, those persons only can determined affected with nervous deafness whose conducting power the bones the head deficient, and who are under forty years age.' Bonnafont still better satisfied with his means dia£nosis, for believes, and takes credit himself for having made a new and great diagnostic discovery, that the sensibility the auditory nerve must perfectly normal if the watch heard all parts the cranium and when the watch heard only at the mastoid and zygomatic process, the hardness hearing still curable if the watch heard nowhere the skull, but the tuning-fork at the third octave heard five centimetres from the ear, or at least at any point the skull which may applied, considers the curability the hardness hearing as very doubtful finally, if the tuning-fork heard only a short distance from the ear, or when applied the skull, the incurability the functional disturbance the ear cannot doubted.

Here again arises the difficulty that the patients themselves must determine whether they hear or do not hear the watch or tuning-fork. Mr. Hinton, surgeon aurist Guy's Hospital, has published a selection twenty-three cases, from which have availed ourself some affections classed as nervous deafness, and gives the following signs which any given case deafness may inferred depend upon a disease the Guy's Hospital Eeports, Third Series. The history. This in many cases itself decisive, especially when connects the defect hearing with other nervous derangements.

The history, however, may very misleading if too much relied upon some the most marked forms nervous deafness, especially those sudden origin, being liable closely simulated simple mechanical obstructions.

Among the most frequent causes nervedeafness, besides blows the head and the effect extremely loud or long-continued noises, are fever, sunstroke, best thesis writing services mumps, diphtheria, parturition, prolonged residence in India.

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Convulsions in childhood stand as the origin many cases, but a question whether, in a large proportion these, the convulsive seizures have not been an effect the ear disease. Certain peculiarities the hearing such as the hearing better in a noise as when riding, or hearing worse on excitement, depression or fatigue, or any special attempt listen.

A much better hearing for some sounds than for others, as for example, for project proposal writing services the watch as compared with the voice, a suspicious circumstance also a great diminution. It might have been supposed inasmuch as hear our own voice partly through the cranial bones, and its resonance decidedly increased closure the meatus that some value might attached the patient's own manner speaking, whether loud or low since this seems to depend mainly the degree in which his voice heard.

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But though as a rule, at least in the more recent and less extreme cases, this supposition seems hold good, there are too many exceptions allow any practical value. Many patients with recent tympanic deafness complain that their own voice sounds loud them and the loud and harsh sounds uttered deaf mutes an extreme instance the tendency raise the voice in those whose nervous faculty A certain value attached the degree deafness, which if very excessive cannot depend absence of conduction but difficult draw the line.

It seems certain that disease the conducting apparatus may reduce the hearing a lower pitch than its congenital THE TUNING-FORK IN DIAGNOSIS OF NERVOUS DEAFNESS.

Certain tests can applied the hearing means a tuning-fork placed the head, which will sometimes give almost or quite decisive information. Little value can attached the mere fact that a tuning-fork any proofreading service online particular pitch heard badly, or even not at all, through the cranial bones, since not only various diseases the tympanum produce this effect, but I have known at least one person, with healthy ears and perfect hearing for the voice, entirely unable hear a tuning-fork upon the head. But since this peculiarity rare, an inability hear vibrations thus imparted the do my college paper cranial bones may fairly held as a suspicious circumstance, and at least the converse may held valid that, if the tuning-fork well heard, the deafness is not likely nervous. But the chief use the tuningfork in diagnosis rests the simple fact that its help me write a thesis statement vibrations, when imparted the bones, pass outward freely through the tympanum and external meatus, and are therefore reinforced reflection when either the tympanum or the meatus rendered impervious sound. If the meatus a healthy ear closed the finger, the sound a tuning-fork placed the head becomes louder, and the same the case with sounds produced our own vocal organs, when the mouth closed, the escaping vibrations being thrown back upon buy essay the labyrinth. If the meatus obstructed wax, the ear being otherwise healthy, the effect the same again, if the passage vibrations through the tympanum hindered closure the Eustachian tube. It may, indeed, laid down as fairly ascertained that whatever diminishes the permeability the tympanum or meatus for sonorous vibrations, causes the bone-conducted sounds ceteris paribus, better heard. 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