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D. R. McIntyre, M.D.
JAMA. 1933;101(4):278. doi:10.1001/jama.1933.27430290004010c.
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R. H., a white man, aged 54, an American lawyer, consulted me, March 6, 1933, complaining of a blowing, pumping, steam-like noise in the left ear, together with extreme nervousness, anxiety, headache and easy fatigue.

The noise in his left ear began in February, 1928, with a sudden onset while he was at ease reading in his library. Having just recovered from otitis media in the right ear, he first thought that possibly a like condition was making its appearance in the left ear. He consulted an ear specialist but a pathologic condition was not found. There had been no noticeable change in the noise heard, but he had progressively become more uneasy about his condition until he had reached the stage bordering on a nervous breakdown.

The patient was well developed and fairly well nourished. On examination there was some swelling on the left side, and the external veins


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