Otitis

“ 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) . ”

“ 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. ”

“ 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. ”

“ 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. ”

“ When the adenoids encroach upon the Eustachian cushions, the patient suffers from deafness, frequent attacks of earache, and sometimes from suppurative otitis media with a discharge from the ear.
Among the rarer conditions attributed to adenoids are asthma, inspiratory laryngeal stridor, persistent cough, chorea, and nocturnal enuresis.
A diagnosis should never be made from the symptoms alone; an attempt must be made to examine the naso-pharynx by posterior rhinoscopy and by digital examination. The interior of the nose must always be examined and any further cause of obstruction excluded. ”

“ Death not infrequently occurs in chronic otitis media in another way. The otorrhoea, after months or years, suddenly ceases, the child complains of constant severe headache and is feverish, and the case ends in coma, preceded perhaps by convulsions. Meningitis has occurred, produced by extension of the inflammation through the thin bony septum which divides the tympanum from the cranial cavity, and at the autopsy hyperæmia of the meninges, fibrin, pus, perhaps softening of the brain and an abscess, are formed in the portion of the encephalon adjacent to the tympanum. ”

“ 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. ”

“ Insurance companies refuse to take risks on the lives of persons affected by chronic otitis media, as it is called scientifically. Such persons may run along in perfect good health for years without accident, but a sudden stoppage of the flow may be the signal for the formation of the brain abscess, with almost inevitable death. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The subject of the hygiene of the ear is so intimately connected with conditions influencing the nose and throat, which have already been explained, that but few words are needed to cover this part of my subject. In general, the best care of the ear is to leave it alone. Ear scoops are injurious; the ear should be cleaned simply on the outside, and nothing, as a rule, should be inserted into the external canal. I have seen many cases of abscess and the most severe inflammation due to endeavors to clean the ear with the omnipresent hairpin and other objects used for this purpose. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The air in the middle ear then becomes absorbed in part, and a species of vacuum is produced with increased pressure from without on the eardrum. The drum membrane will be pressed in, and through the little bones pressure will be made against the sensitive nervous apparatus, irritating it and giving rise to deafness, dizziness, and the sensation of noises in the ear. Noises from without will also be intensified in passing through the middle ear when it is converted into a closed cavity through the blocking of the Eustachian tube. ”

“ A third view is that the filaments from the hair cells, rather than the basilar membrane, respond to the vibrations and in turn stimulate the terminations of the nerve fibers.
Fig. 155—Diagram showing how wax may plug the auditory canal and cause deafness. Hygiene of the Ear.—The ear, being a delicate organ, is frequently injured by careless or rough treatment. The removal of the ear wax by the insertion of pointed instruments has been found to interfere with the natural method of discharge and to irritate the membrane. It should never be practiced. ”

“ 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. ”

“ Deafness is frequently present, varying in degree, transient and persistent. Attacks of earache are common and also running of the ears. The ear troubles often arise from the extension of catarrh from the nose-pharynx through the eustachian tubes to the middle ear. Sometimes the adenoids block the entrance to the tubes. The ventilation of the middle ear may be impeded. ”

“ Abstain from alcohol, tobacco and excess of all kinds. Active outdoor exercise, horseback riding, mountain climbing, rowing, walking, etc., are great health producers.
ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.—This inflammation of the middle ear is one in which, at an early stage of the disease, the free liquid poured out assumes a pus-like character. At the onset the mucous membrane of the eustachian tube and middle ear becomes first congested and afterward oedematous (watery swelling) . Then a serous or a bloody-serous fluid is poured out into the middle ear ”

“ 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. ”

“ The middle ear or tympanum (fig. 1, p) is a small cavity in the temporal bone, the shape of which may perhaps be realized by imagining a hock bottle subjected to lateral pressure in such a way that its circular section becomes triangular, the base of the triangle being above. The neck of the bottle, also laterally compressed, will represent the Eustachian tube (fig. 1, l) , which runs forward, inward and downward, to open into the naso-pharynx, and so admits air into the tympanum. ”

“ Of much graver importance, of course, is the internal inflammation of the ear, formerly complicated at times with an acute earache, with which he has now been afflicted for a number of years. Just what the affection is no one has yet been able to determine. It grows worse in cold and wet weather, and that is about all that is known of it. ”

“ If there is more motion of one ear than the other, if the head is jerked to the one side, if there is a measure of deafness in the one ear (to be ascertained rather in the intervals between attacks) , if there is disease of the pharynx, the Eustachian tube or pouch, or swelling about the root of the ear, if there is wax, scurf, or acarus in the ear, if the animal rubs it frequently, aural vertigo may be suspected. ”

“ For thirty years this patient had heard nothing with the right ear, and very little with the left. I stimulated, with a stiff, curved cotton-tipped probe (instrument shown in Fig. 6 may be used) , the area lying between the last tooth and the angle of the jaw—carefully “covering” all the gum surfaces—sides as well as biting surfaces.
In addition, I hooked an instrument behind the soft palate (see D, Fig. 11) , and “stretched” it gently forward. This, I have found, powerfully stimulates the circulation of the “ear zones,” and is most helpful—particularly in catarrhal deafness. ”

“ 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. ”