Labyrinthine Vascular Disorders

Mv own interest in these conditions commenced when I met James Seymour at the Middlesex Hospital six years ago. The stimulus which he gave me then has been the major factor in producing this paper to,night. Seymour, six years ago, knew from his clinical association with the late Garnett Passe (1945, 1951, 1953) that certain labyrinthine disorders responded to local vasodilation-either by drugs, sympathetic block, or sympathectomy. He had himself injected a case with acute labyrinthine vertigo and seen the dramatic alleviation of symptoms it produced. Seymour has actively been investigating these disorders from the experimental and histological viewpoints since then (1953). Like Sherlock Holmes, however, he required his Watson, a clinician, interested in .deafness, not hidebound by conventional theories of deafness, and with a basic training in audiometry, surgery, and scepticism. He had had some difficulty in interesting any clinician in this work until our paths crossed in 1950. It was not, however, until 1953, when I had completed the build-up of a complete otological unit at Omagh, that I was able to begin an investigation into these disorders. I had by that time discovered that inner ear symptoms were as common or commoner in Ulster as in England, and that they were no better treated. Eustachian catheterisation sedation and psychiatric consultation were still the order of the day. In the majority of patients with these symptoms clinical examination of the ears and central nervous system proves completely negative. Further investigation can only be done by a scientific examination of the function of both cochlea and vestibule. The procedure of making a diagnosis is, of course, still essentially a clinical one, a good history being of paramount importance, but a diagnosis cannot be reached without routine audiometry, recruitment tests, and tests of vestibular function. The audiometer is as essential to the clinician dealing with deafness as the X-ray machine to the orthopaedic surgeon, or the electrocardiograph to the cardiologist. The type and degree of deafness and the success or otherwise of all forms of treatment should be measured on the audiometer or by repetition of the 41