Otitis media

“ The mucous membrane is deep-red or greenish in purulent inflammation; yellow, creamy pus, often of very offensive odor, may be found in middle ear, Eustachian tube or external canal. Note character of perforations; old ones have smooth and thickened edges. The most important pathologic conditions are: otitis media purulenta, inflammation of mastoid cells, caries of mastoid process, sinus-thrombosis (leading to meningitis or pyæmia) , otitis media tuberculosa, granulomatous polypi, cholesteatoma, sclerosis, congenital anomalies, foreign bodies, parasites, neoplasms (chiefly of external ear) . ”

“ Other inflammatory complications and sequelæ, which have been described in the preceding pages, retard convalescence and jeopardize the life of the patient, such as empyema, endocarditis, pericarditis, and pneumonia. Otitis media is seldom immediately dangerous, although it may be painful and involve serious consequences, even a fatal meningitis, as has been stated above, after months or years of otorrhoea. Anomalous cases are believed to be, as a rule, more dangerous than such as are [p. 536] attended by an early and full efflorescence and have the usual symptoms. ”

“ More frequent even is disease of the auditory apparatus, and purulent otitis media or disease of the labyrinth may lead to permanent deafness. Serous effusion may take place into joints which are painful, red and swollen as in acute rheumatism. ”

“ Frequently, the otitis escapes detection, its symptoms being masked or obscured by the general disease, until the membrana tympani is perforated and otorrhoea begins; but by careful examination the nature of the complication can usually be ascertained before the ear is injured to this extent, for a patient too young to speak will often press with the fingers against the painful ear or lie with the ear pressed upon the pillow, evidently having an increase of suffering if placed in any other position. ”

“ Acute Otitis.—Inflammation of the ear seldom occurs in childhood, unless as a complication, or as a result of some infectious disease. Any disease which affects the throat in any way may be the cause of the inflammation of the ear. Such diseases are, "cold in the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles, scarlet fever. It is much more common in children than in adults. The younger the child, the more liable it is to develop ear trouble when suffering from any of the above diseases. The presence of adenoids favors the development of ear complications. ”

“ For some years this specialty throve on the otitis acquired at the bathing-houses at Rockaway and Coney Island, but the public discovered that a little cotton in the meatus was the needful prophylactic, and otitis, as a source of revenue, dwindled to the starvation point. Again, and for a time, the horn of plenty overflows in the otologist’s operating room, and his commissions to the car conductors promise to put them soon on a plane with the diamond-bedecked shirt-fronts of the average hotel clerk. ”

“ Odontalgia may be distinguished from otitis by the application of cold water to the affected tooth; for as the pain of common tooth-ach is owing to torpor, whatever decreases stimulus adds to the torpor and consequent pain; whereas the pain of an inflamed tooth being ceased by the increased action of the membranes of it is in some measure alleviated by the application of cold.
8. Otitis. Inflammation and consequent suppuration of some membranes of the internal ear frequently occur in children, who sleep in cold rooms, or near a cold wall, without a night-cap. ”

“ The ear trouble (otitis) usually occurs during the scaling. The patient may be up and around. There is a rise of the temperature to 103 or 104 degrees, the patient begins to vomit food and has a headache. At night the child starts from its crib and cries as if in pain. They do not always locate the pain in the ear. The face and hands may twitch. The fever may fall to normal and rise sharply again. Such symptoms should call for a thorough examination. ”

“ If there be no middle-ear suppuration. Operation is not urgent, but is justifiable under the following conditions:—
(i) When one ear only is affected. (a) If there be complete deafness due to obstruction of the auditory canal. The question of operation, however, should be decided by the patient, because it may be postponed indefinitely so long as no symptoms occur.
(b) If there be recurring attacks of discomfort or of pain in the ear as a result of eczema, of otitis externa, or of actual pressure of the growth itself. The patient may desire operation to obtain permanent relief. ”

“ Many cases, indeed, have occurred of injury to the ear, producing permanent deafness, from descents in diving bells, undertaken by persons ignorant of the way in which the ear is made; though the simple precaution of frequent swallowing suffices to ward off all mischief. For, if the Eustachian tube is thus opened, again and again, as the pressure of the outside air increases, the same compressed air that exists outside passes also into the inside of the drum, and the membrane is equally pressed upon from both sides by the air, and so is free from strain. ”

“ A strange case is reported in a girl of fourteen, who lost her tympanum from a profuse otorrhea, and who substituted an artificial tympanum which was, in its turn, lost by deep penetration, causing augmentation of the symptoms, of the cause of which the patient herself seemed unaware. Sometimes artificial otoliths are produced by the insufflation of various powders which become agglutinated, and are veritable foreign bodies. Holman tells of a negro, aged thirty-five, whose wife poured molten pewter in his ear while asleep. It was removed, but total deafness was the result. ”

“ Not sharing the etiological superstition which attributes so many diseases of infancy to dentition, I still know that a slight irritation of the gums may suffice to exhaust the slim resisting power of the infant. If there be local swelling and congestion of the gums over a growing tooth, it may become necessary, or at least advisable, to lance. An otitis which under ordinary circumstances would give rise to no symptoms at all besides some inconvenience or slight pain will prove the source of great danger in a rachitical (craniotabic) infant. ”

“ Detection of slight deafness may lead to the discovery of serious defects of nose or throat. Inflammation from cold or catarrh may cause deafness, which if neglected may permanently injure the ear. Often deafness is due to an accumulation of wax. A running ear should receive immediate attention, as it is an indication of inflammation which may imperil the integrity of the eardrum, and, if neglected, may eat its way through the thin partition between the ear and the brain and cause death. ”

“ If a person on blowing the nose violently, feel a swelling in the ear, from the membrane of the tympanum being forced outwards, the tube is open; and though the tube be closed, if the beating of a watch placed between the teeth, or pressed against the side of the head, cannot be heard, the operation cannot relieve, as the sensibility of the auditory nerve must have been destroyed. In a closed Eustachian tube, there is no noise in the head, like that accompanying nervous deafness. ”

“ The watch and human voice would only show the ear to be defective in its hearing power, and it may be from any of the above-mentioned causes. The tuning-fork, in vibration, placed on an incisor tooth or on the frontal bone, would bring out the fact that if the deafness was due to a diseased middle ear or obstruction in the external auditory canal, the tuning-fork would be heard best by the defective ear; but if due to a disease of the internal ear, it would be heard the least distinctly by the defective-hearing ear. ”

“ The eardrum is not absolutely essential to hearing, but it is of great importance to exclude sources of irritation, dust, water, and germs which are likely to set up middle-ear trouble. More ordinary after-effects are chronic discharge from the ear following acute inflammation and perforation of the eardrum, which may mean at any time a sudden return of pain with the occurrence of the more dangerous conditions just recited, together with deafness. ”

“ It is unnecessary in the healthy ear thus to cleanse the auditory canal, as the wax is passed by a natural process to where it is easily removed by a damp cloth. If the natural process is obstructed, clean warm water and a soft linen cloth may be employed in cleansing the canal, without likelihood of injury. Clean warm water may also be introduced into the auditory canal as a harmless remedy in relieving inflammation of the auditory canal and of the middle ear. Children's ears are easily injured, and it goes without saying that they should never be pulled nor boxed. ”

“ Food particles collect in the mouth and provide culture material, and there are many crypts and irregularities of surface which oppose mechanical cleaning. Infection of the middle ear, the most common cause of deafness, takes place by means of the Eustachian tube which connects the cavity of the ear with the mouth. Organisms from the mouth can extend into the various large salivary glands by means of the ducts and give rise to infections. The tonsils, particularly in children, provide a favorable surface for infection. ”

“ If the patient is a woman, who because of offensive breath is barred from society, she will become morbid and hypochondriacal in time. There is so much of the thick mucus hanging on the walls of the pharynx that the openings into the eustachian tubes are filled up and in a short time a certain degree of deafness appears—roaring in the head and other manifestations of ear trouble. As soon as the hearing is noticed to be abnormal the patient will be ready to consult some physician. ”

“ Bartholinus, Lycosthenes, Pare, Schenck, and Oberteuffer have remarked on deficient external ears. Guys, the celebrated Marseilles litterateur of the eighteenth century, was born with only one ear. Chantreuil mentions obliteration of the external auditory canal in the new-born. Bannofont reports a case of congenital imperforation of the left auditory canal existing near the tympanic membrane with total deafness in that ear. Lloyd described a fetus showing absence of the external auditory meatus on both sides. ”

“ At a variable time after the receipt of an injury to the head the patient may complain of headache, followed by a chill, with high fever, vomiting, vertigo, delirium, unconsciousness, convulsions, etc., arising from compression by the products of inflammation. The same phenomena may follow the transmission of inflammation to the dura from caries or other disease of the bones, or from otitis medea purulenta. ”

“ Whenever water is forced from the mouth and nostrils into the middle ear through the Eustachian tube, inflammation of the middle ear is almost sure to occur, even though the water be warm. According to the author, several thousand severe cases of aural disease result annually from bathing in New York City alone. ”

“ With respect to the external ear in man, whether it is completely removed either by accident or design, deafness ensues, although its partial removal is not attended with this inconvenience: the external ear, therefore, or something in its form to collect sound, is a necessary part of the organ.
The next division is the intermediate ear; it consists of the tympanum, mastoid cells, and Eustachian tube. The tympanum contains four small delicate bones, viz. the malleus, the incus, the stapes, and the os orbiculare, joined to the incus. ”

“ IX.—On the Nature and Treatment of those Diseases of the Ear which have hitherto been designated Otorrhoea and Otitis. By Joseph Toynbee, F.R.S., Fellow of the Royal College of Surgeons in England; Aural Surgeon to St. Mary's Hospital; and Consulting Surgeon to the St. ”

“ In the open air the hearing is better than in a confined situation; in a noisy, than in a quiet society; in a coach when it is in motion, than when it is still. A pulsation is often felt in the ear; a noise resembling sometimes the roaring of the sea, and at others the ringing of distant bells is heard. This deafness generally begins with a diminished secretion of the wax of the ear, which the patient attributes to cold. ”

“ The lining of the inner ear is a continuation of the lining of the nose and throat. If the latter becomes infected, as with a cold, directly or from enlarged tonsils or adenoids, the infection is likely to continue into the ears, causing running ears, which may result in deafness. ”

“ Now if this tube swells so much that it entirely closes, as so often happens in cases of "cold in the head" as well as in constant irritation from adenoids, then may follow a vast train of difficulties—earache, mastoiditis, etc.—with the result that the tiny bones in the middle ear which vibrate so exquisitely may become ankylosed (stiffened) and deafness often follow. Everything known must be done to prevent baby's catching "cold in the head." If the sinuses become infected it may also lead to serious consequences. ”

“ Sometimes water that gets in this way causes inflammation and cold, which hurt the sense of hearing. No one should ever strike another on the ear, even in play. It is likely to cause deafness. What is called the drum of the ear is a very delicate membrane which receives the sound. ”

“ Many times patient will complain more of the deafness than anything else. When you have this complication it will be necessary to give attention to some special treatment for the pharynx and eustachian tubes. The latter must be kept open by Valsalva’s method or the Politzer air bag.
In selecting the internal remedy keep in mind the constitutional and local lesions. Often I use the internal remedy locally; say 5 to 20 drops of tincture to ounce water. Make yourself confident that you have the indicated remedy. There are many remedies which are of service. ”