PEHCEI'TIVE DEAFNESS I N C O N N E C T I O N WITH RlUMI'S

A Study of 298 Servicemen srr/rering f r o m Miimps

Two hundred and ninety-eight servicemen being treated for epidemic

parotitis at Military Hospital 2 in Turku were examined audiometrically
and otologically. The purpose of the examination was t o throw light upon
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the following questions:

(1) How often does perceptive deafness occur in connection with mumps;
(2) Does hearing improve later, and if so, how often, in the observed
cases of deafness; and
( 3 ) Do patients suffering from mumps induced meningitis exhibit affected
hearing more frequently than patients suffering only from mumps?
I t was seen that perceptive deafness in connection with mumps:
( a ) is not rare. Hearing loss occurred in 13 patients (4.4 21.2 %).
( b ) is usually reversible. Hearing became completely normal in six patients
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and almost normal in six patients, remaining unilaterally constantly

and seriously affected in only one patient.
(c) has no correlation with mumps induced meningitis.

I t was also seen that mumps induced deafness mostly appears in high
tone range and that it may be bilateral.

It h a s been known for a long time that mumps is one of the m a n y factors
apt to cause s u d d e n perceptive deafness. According to former opinions the
typical deafness d u e to m u m p s is unilateral, of severe nature, irreversible
a n d very rare. O n the basis of more recent investigations m u m p s seems,
however, capable of causing bilateral deafness, which is b y no means always
irreversible. It has also been possible to show that m u m p s , as well as certain
other viral diseases, m a y bring about deafness m u c h more frequently t h a n
had earlier heen supposed.
Dishoeck di Bierman (1957) publish a material where 66 cases of deafness
have been carefully studied regarding the pussihility of viral infection being
the probable cause of deafness. All the patients had sought medical care
within three months of the appearance of their illness. T h e presence of viral
infection could b e seen i n 21 patients. Mumps infection w a s present i n
fourteen cases, a n infection of the influenza group i n seven, a n d a n infec-
tion of the poliomyelitis group i n seven cases; two o r even three tlil'ferent viral
infections could b e observed in some of the patients at the s a m e time. I n all
t h e observed virus infection cases the authors considered the deafness to he
d u e to the infection b u t they were also of the opinion that in a n u m b e r of the

A c f a oto-laryng. 55
 232 V U O R I ET A L .

rcrnaining cases the deafness could also well be attributed to the same cause,
for many of the patients presented themselves for investigation so late that
llic probable occurrence of a viral infection at the time of Ihe appearance of
deafness could no longer be verified. Part of the defects were bilateral and
in many cases a definite improvement of hearing could be observed at the
second examination as compared with the first.
Saunders & Lippy (1959) present nine cases of sudden perceptive deafness,
which were also examined virologically. The presence of mumps infection
could be shown in four cases definitely and in another two probably. Ac-
cording to the writers deafness was most likely due to this infection. All
the cases were unilateral ones. In one case hearing improved from 50 db
level to near-normal within three weeks, in four cases deafness of some 90 db
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improved to 40-60 d b level and in only one case deafness remained perma-
nent.
The Present Study
The present study was undertaken to throw more light upon the following
questions:
(1) How often does perceptive deafness occur in connection with mumps;
(2) Does hearing improve later, and if so, how often, in the observed
cases of deafness; and
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(3) Do patients suffering from mumps induced meningitis, exhibit afrected

hearing more frequently than patients suffering only from mumps?
The material consists of 298 cases, i.e. all the servicemen being treated for
mumps at the Military Hospital 2 in Turku within the period from January 1,
1958 to April 30, 1961. Parotitis could be observed clinically in all the cases.
Lumbar puncture and cell count from the spinal fluid were carried out in
every case.
A pure tone audiogram was taken from every patient as soon as possible
after the patient’s admittance to hospital, and another when treatment was
over. If subjectively observable changes in hearing occurred when in hospital,
the patients were told to report those so that probable changes could be
registered immediately. When a patient’s hearing was audiometrically ob-
served to he deviating from normal, it was tried to find out the cause of the
deafness on the basis of the earlier case history and the patient’s otologic
status. The cases where deafness was considered, on this basis, to be due to
mumps were observed through repeated audiometric examinations even
after the patients had left the hospital.

RESULTS
The audiometric studies carried out in connection with 298 patients sufrer-
ing from mumps revealed such affected hearing as was considered to he due
to mumps in thirteen cases (4.4 & 1.2 %). All these cases are presented se-
parately in Table 1.

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 Perceptive Deafness in Connection w i t h Mutnps 233

TABLEI. Audiometric findings.

Frequency
Date of I

Case no. Diagnosis tests 250 500 1000 2000 4000 6000 8000

918158 Parot. epid. 5-26-58 0 -5 0 0 5 0 0

c. mening. 6-13-58 20 15 20 30 30 30 30
7-5-58 0 0 5 10 20 25 30
4/59 Parot. epid. 1-7-59 10 5 5 20 45 40 35
c. mening. 1-27-59 5 0 0 0 25 5 0
6/59 Parot. epid. 1-7-59 0 -5 - 10 20 45 20 15
c. mening. 1-29-59 -5 -5 - 10 0 20 5 0
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293159 Parotitis epidemica 2-18-59 5 5 5 15 15 65 50

3-18-59 5 5 5 15 15 25 20
6-6-59 5 5 5 15 10 20 20
415/59 Parotitis epidemica 3-2-59 20 5 10 25 30 15 15
3-14-59 5 0 5 15 15 10 5
3-31-59 -5 -5 -5 5 10 0 -5
528159 Parot. epid. c . mening.
Right ear 3-19-59 0 0 0 0 80 55 55
3-23-59 0 0 -5 -5 0 0 -5
Left ear 3-19-59 0 0 0 0 40 85 50
0 0 0
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3-23-59 0 0 0 35
4-10-59 0 0 0 0 -5 -5 -5
666159 Parot. epid. 4-12-59 0 -5 - 10 -5 -5 -5 -5
e. orch. 4-21-59 5 -5 -5 15 45 30 0
7-5-60 -5 -5 -5 - 10 15 -5 -5
605 /60 Parotitis epidemica 4-1-60 20 20 20 15 35 30 40
4-25-60 0 -5 0 0 -5 15 0
828/60 Parotitis epidemica 5-9-60 10 5 15 20 75 50 45
5-18-60 45 45 60 70 75 50 45
8-16-61 55 60 75 80 95 70 60
846 /60 Parotitis epidemica
Right ear 5-12-60 30 30 30 35 45 35 40
5-30-60 0 15 10 20 45 35 40
6-28-61 0 0 0 10 20 0 5
Left ear 5-12-60 30 30 30 45 50 40 40
5-30-60 0 10 0 20 35 10 0
6-28-61 0 0 0 0 10 0 0

854 /60 Parotitis epidemica 5-13-60 5 0 5 25 35 25 0

6-9-60 0 0 5 15 5 0 0
8-14-61 0 0 5 15 5 0 0
1683/60 Parotitis epidemica 12-1-60 15 0 0 5 25 40 35
12-10-60 5 0 0 5 0 40 20
12-29-60 0 -5 -5 -5 0 10 15
93/61 Parotitis epidemica
Right ear 1-11-61 10 5 10 30 40 0 5
1-20-61 0 -5 5 20 20 0 5
9-13-61 0 -5 5 0 15 0 0
Left ear 1-11-61 5 5 5 20 30 15 15
1-20-61 0 -5 0 15 5 5 0
9-1 3-61 0 -5 0 5 0 0 0

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 234 V U O R I ET AL.

Tahle 1 shows that:

(1) Two patients (018/58 a n d 666/59) exhibited completely normal hearing
when admitted to hospital. T h e former developed a slight perceptive deafness
lvhich was observable throughout the sound range a n d which improved
gradually to normal for low tones, a slight defect remaining for high ones.
During hospital treatment the latter patient developed fairly severe high tone
loss, which disappeared by degrees.
(2) Slight perceptive deafness affecting the whole sound range was ob-
served in two patients (605/60 a n d 846/60) when they were admitted to
hospital. I n the former case the defect improved to normal quite rapidly;
in the latter case hearing improved more slowly a n d a slight defect in hearing
was observed at 4000 cps in a follow-up examination carried out a year after
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the treatment.
(3) M'hcn taken to hospital nine patients exhibited moderate or severe
deafness almost exclusively at the high tone range. I n eight cases the defect
disappeared either completely or almost completely within a few weeks.
I n one case (828/60) hearing continued to deteriorate a n d the condition
clevelopetl into severe a n d constant deafness which covered the whole tone
range.
(4) Among the patients suffering from defective hearing there \\-ere four
cases (about 30 %) with m u m p s induced meningitis. I n all the cases the
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defects were quite slight a n d in one of them hearing rapidly returned to

normal, slight defects remaining in the rest of the cases. In the whole material
83 patients (about 28 "/o) h a d mumps induced meningitis. N o correlation
could be seen between hearing defects, on the one h a n d , a n d the clinical
picture or the laboratory findings obtained for the patients suffering from
meningitis, on the other. T h e number of the cells in the spinal fluid was
346-1 7 l/mrn3 for such meningitic patients as exhibited hearing defects.
Even greater numbers of cells were observed in several cases in connection
with such meningitic patients a s exhibited no hearing defects a n d the only
patient in the material whose hearing remained constantly severely affected
(828/60) was not suffering from meningitis at all.
(5) In three cases slight deafness was observed in both ears, in every one
of them the condition was quite symmetric.

Co mI I I e n t
The investigation carried out has shown that perceptive deafness in
connection with m u m p s in a material of patients at the age of 20:
( a ) are not very rare;
( b ) are mostly reversible a n d affecting the high tone range; a n d
(c) have no correlation with m u m p s induced meningitis.
On the basis of the present material it seems likely that deafness in connec-
tion with mumps is not very rare a n d that it is almost always reversible,
hearing gradually becoming either normal or at least practically normal.

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 Perceptive Deafness in Connection with M u n i p s 235

Hearing remained severely defective in only one patient (828/60) of the total
material. This one case does not permit even a rough estimate to b e 6' mTen
regarding the frequency of s u c h m u m p s induced hearing defects as are
constant a n d of real hindrance to the patient, particularly as one h a s to hear
in mind that almost every person that comes into contact with patients suf-
fering from m u m p s will get a m u m p s infection without manifest parotitis
and m u m p s induced hearing defects m a y as well occur in them, as shoxvn
by Dishoeck !C Bierman (1 957) a n d Saunders L! 1-ippy (1 959). A rough calcula-
tion m a d e b y the present authors shows that m u m p s causes annually some
25-30 cases of severe deafness of constant nature i n Finland (about one case
per 200,000 people). It is quite obvious that m u m p s as we11 as other viral
conditions cause perceptive deafness considerably more frequently t h a n is
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generally assumed, for although most of the patients with serere hearing
defects will seek medical treatment it is still likely that in a good m a n y cases
1 1 0 viral examinations a r e undertaken w h e n trying to find out the etiology of
the deafness.
In connection with a material that consists of servicemen one is easily
led to suppose that high tone loss would b e caused b y firing practice. Through
the use of anamnestic d a t a it has been tried to m a k e the p a r t played b y this
possibility as small as possible. Thus, for instance, all the 13 patients whose
deafness w a s supposed to b e d u e to the m u m p s h a d not taken part in any
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firing practice within 10 days before the occurrence of their illness. But
nevertheless the possibility is still present. However, cases 666/59 a n d 828/60
entitle us to conclude that m u m p s induced hearing defects mostly appear in
the high tone range. I n the former case hearing w a s normal xvhen the patient
was taken to hospital, a n d the defect appeared only after that i n the high
tone range; i n t h e latter case the hearing defect w a s at first noticeable for high
tones a n d only later it also spread to include the low tones.

ZUSAMMENFASSUNG
298 Wehrpflichtige, die wegen Mumps im Militiirkrankenhaus i n Turku behandelt
wurden, sind audiometrisch und otologisch untersucht worden. Der Zweck der
Untersuchung war, folgende Fragen klarzustellen:
(1) wie gross ist der Prozent der Mumps-Patienten, bei denen perzeptive Schwer-
horigkeit auftritt;
( 2 ) kann sich das Gehor spater bessern, falls ja, wie oft in den Fallen, wo diese
Krankheit Schwerhorigkeit verursacht hat; und
( 3 ) tritt Schwerhorigkeit ofter auf bei solchen Mumps-Patienten, bei welchen als
Nebensymptom Meningitis aufgetreten ist, als bei solchen, welche die Krank-
heit ohne dieses Symptom durchmachten?
Auf Basis dieses Materials ist festgestellt worden, dass die perzeptive Schwer-
horigkeit bei den Mumps-Patienten:
( a ) nicht selten ist. Eine Verschlechterung des Gehors wurde bei 13 Patienten
festgestellt (4,4*2,2 yo).

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 236 V U O R I Err AL.

( b ) meist reversibel ist. Bei sechs Patienten wurde das Gehor wieder vollig normal,
und bei sechs anderen wurde es fast normal, sodass die Verschlechterung des
Gehors, in verhaltnismiissig schwerer Form, nur bei einem Patienten bestehen
blieb.
(c) keine deutlich erkennbare Wechselwirkung zwischen der Meningitis und dem
Auftreten der Schwerhorigkeit besteht.
Die Schwerhorigkeit t r i t t a m haufigsten auf dem Gebiete der hohen Laute auf,
und kann auch doppelseitig sein.

REFERENCES

DISHOECK, H. A. E., and BIERMAN,

TH. A., 1957: Sudden perceptive deafness and viral in-
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VAN
fection. A n n . Otol. 66, 963.
SAUNDERS,W. H., and LIPPY,W. H., 1959: Sudden deafness and Bell's palsy: a cotninon cause.
A n n . Otol. 6 8 , 830.

Hospital 2, l'urku, Finlonrl

iVIilitar~~
Received June 4 , 1 9 6 2
For personal use only.

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