Deafness remains the most important problem in otology despite good results recently obtained with surgical procedures such as fenestration and stapes mobilization. Since deafness results from long evolving processes, a logical approach to the problem would be not to wait for the advanced stage where surgery must be used but to try to control the processes before they reach this ultimate state which usually corresponds to sclerosis. Studies of the morphological changes related to progressive deafness have been too limited to present a basis for a biological or biochemical therapeutic approach that would have a chance of success. The nature of the lesions, their minuscule dimensions, and their chronic evolution, offer no opportunity for direct information. Consequently, we tried to adapt to this situation the knowledge acquired through research in the field of abnormal processes in general.

Just as for pain, it was observed that some patients with hearing impairment are aware of differences in their acoustic acuity according to the time of day, i.e. some hear better in the morning, some in the evening. There seemed also to be a correlation with the intake of food. Based on these observations, cases of various degrees of surdity were investigated for relationship to acid base changes. Some subjects showed audiometric variations under the influence of acidifying or alkalizing agents, while others did not respond. When two antagonistic agents were used in the same subject and hearing acuity was analyzed, the changes occurred in two opposite directions. We could interpret this only by analogy to changes in pain and other acid base symptoms. Accordingly, we postulated that in some cases no activity is going on in the lesions since no changes are induced in the audiogram by administration of acidifying or alkalizing agents; in others, there is activity which is acid or alkaline in pattern.

Thus, the existence of a response was considered to indicate a still active lesion. Time is not the determining factor. Even in relatively recent lesions, biological activity may have ceased while in other cases, even with very advanced hearing impairment, lesions can still be evolving, with processes not yet advanced to the sclerotic scar phase. This aspect has been extensively studied because of the therapeutic implications, since only an evolving state could possibly be influenced by this method of therapy.

The influence of agents used in other conditions with acid base pathogenesis was studied in cases of impaired hearing. The first attempt made years ago, with fatty acids and sterol preparations, was not successful. Much better results have been obtained with more recently developed synthetic agents. In the last five years, Welt has devoted much time and effort to this research. He has made thousands of complete audiograms and has used a series of active agents with placebos for control. (192) Welt has studied approximately 460 cases to date. (Note 5) In the simplified form, an agent from one or the other group was used for a short time and improvement in the audiogram was taken to indicate that a suspected pattern, acid or alkaline, was actually present.

Clinical results have largely confirmed theoretical views. Regardless of degree of impairment, improvement ranged from nil or almost nil in cases with no more signs of activity, to good and excellent in those with still active lesions. In young patients in whom the proportion of active lesions is high, results were particularly impressive. Hearing impairments of 60-70 decibels or more have been overcome, sometimes in only a few weeks of treatment. These results have been observed to persist in many cases, some thus far for more than three years. However, a tendency for impairments to recur, usually following rhino pharyngeal infections, has been noted. Generally, renewed treatment has been able to restore hearing to previous values in a short time. (Figs. 146 to 150)

It appears superfluous to emphasize here the importance of this contribution to the medical and social problem of deafness. It represents the first approach to treat successfully the pathological processes related to impaired hearing before they lead to advanced lesions which can no longer be influenced except by surgery. Every case of incipient or even advanced hearing loss should be investigated by the simple technique devised by Welt to see if correction by this method is still possible. Surgical intervention should be reserved principally for patients with lesions which correspond to sequels and who no longer respond to biochemical treatment. But even surgical cases can benefit from biochemical treatment which could prevent further sclerosis which often follows surgery. Application of this method in time to prevent deafness would be even more important than restoring hearing in far advanced cases.

Manifest improvement in the impaired hearing is obtained in a subject with acid pattern

Fig. 146. Manifest improvement in the impaired hearing is obtained in a subject with acid pattern, through guided treatment with negative lipoids. (Courtesy of Dr. B. Welt.).

In the same patient as in Fig. 146 the improvement is not as manifest for the right ear as for the left ear

Fig. 146bis. In the same patient as in Fig. 146 the improvement is not as manifest for the right ear as for the left ear.

Only a relative improvement is obtained in a case with alkaline pattern of impaired hearing

Fig. 147. Only a relative improvement is obtained in a case with alkaline pattern of impaired hearing.

A still smaller result is obtained in this case for the left ear

Fig. 148. A still smaller result is obtained in this case for the left ear.

An exceptionally good result is obtained for the left ear in the case

Fig. 149. An exceptionally good result is obtained for the left ear in the case A.W.. in spite of an initially very impaired hearing.

Manifest improvements are obtained in this case with alkaline pattern of impaired hearing

Fig. 150. Manifest improvements are obtained in this case with alkaline pattern of impaired hearing.

Itching

Acid and alkaline patterns of itching have been recognized, and treatment based upon dual pathogenesis has been applied. The agent to be used is determined by the pattern found through analyses. Dosage, as for pain, is established according to the subjective response. Following these methods, many cases of intractable itching have been completely controlled. Of the group of agents with positive character, butanol and heptanol have produced the best results; in the opposite group, epichlorohydrin and sodium thiosulfate have been most effective.

Gallbladder And Renal Colic

Attempts were made to influence renal and gallbladder colic by using the same method. Butanol has shown little effect upon renal colic at least in the doses we tried. But the results in gallbladder colic were impressive. A 6.5% solution of butanol in saline injected intramuscularly, or even 15-30 cc. (one or two tablespoonsful) of 6.5% solution of butanol in water administered orally when the patient was not vomiting, controlled gallbladder colic rapidly. Only twice in more than 20 cases in which butanol was used was it necessary to give larger doses, such as 50 cc. of the same solution, to obtain the desired effect.