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Summer Meeting of the Section of Otology of the Royal Society of Medicine

EVERYBODY knows what is meant by deafness and would be unwilling to diagnose deafness unless there is a demonstrable loss on pure-tone audiometry. In the absence of such a loss, the patient would not be called deaf. Galileo was the first to demonstrate the relation between pitch and intensity. Ohm said that the individual components of this complex wave form could be heard by the ear. Corti demonstrated the anatomy and then Helmholtz developed his resonance theory of hearing. Hobbs said that there is no conception in man's mind, which hath not at first totally or by parts been begotten upon the organs of the sense and Hume said that knowledge can only become possible within the limits prescribed by sense experience. In 1922 the first audiometer was developed by Western Electrical Company. Are we not, however, limited in our thoughts by the 'hardware' as it is difficult to conceive of deafness in terms other than those of a loss in pure tone audiometry. In fact, one rarely hears pure tones in nature, above threshold sounds are heard binaurally so the test is somewhat artificial. Why is such importance attached to this test then? It does evaluate the degree of hearing loss and is useful in the differential diagnosis of middle ear, cochlear and VHIth nerve lesions. This does, however, assume that deafness is entirely equatable with hearing loss. In children there is a multiplicity of patterns of hearing response. Many infants, under a year, have a very poor level of responsiveness to pure tone stimuli but will respond at threshold to meaningful everyday sounds. Then there is the perplexing and not uncommon problem of the child of school age who is found to have a 60 dB loss on pure tone audiometry although deafness has never been suspected previously. Another problem case was that of a child of five months whom everybody suspected was deaf. Three months later, however, the child responded perfectly normally to threshold sounds. Can this have been due to a change in cochlea sensitivity? There is also a definite developmental progress in the child's ability to localize sounds, at six months