The external ear is called auricle or pinna. It is an oval funnel-shaped
organ. The canal leading in to the membrane (drum) is called the external
auditory meatus. It extends inward about one and one-quarter inches and
terminates in a membrane.
Membrane Tympani (drum) which separates the external ear from the tympanic
cavity. To examine the drum, you must pull the ear backward and outward to
make the canal straight.
Membrane Tympani (the drum) Membrane.--This is situated at the inner end
of the canal and separates it from the tympanum or middle ear. It is
placed like the membrane in the telephone. It is pearly gray in color.
This membrane not only serves as a protection to the delicate structures
within the tympanum, but also receives the sound vibrations from without
and transmits them to the ossicular (bony) chain of the middle ear.
The Tympanum or Middle Ear.--This cavity just beyond the drum, which forms
the greater part of its outer wall, is an irregular cavity, compressed
from without inward and situated in the petrous bone. The mastoid cells
lie behind. It is filled with air and communicates with the nose-pharynx
(naso-pharynx) by the eustachian tube. The upper portion of this cavity,
the attic, lies immediately below the middle lobe of the brain, separated
from it by a thin layer of bone, which forms the roof of the cavity. This
cavity is separated from the internal ear.
[EYE AND EAR 359]
The Eustachian tube.--This is the channel through which the middle ear
communicates with the pharynx. With an opening in the anterior of the
middle ear, a bony canal passes from this point, inward, forward, and
downward through the petrous bone, when it merges into a cartilaginous
canal, which terminates in a funnel-shaped protuberance, with a slit-like
orifice, located in the nose pharynx. This is the eustachian tube. It is
lined with mucous membrane like the throat. The air goes up from the
throat, through this canal to the middle ear. The mucous membrane of the
middle ear is continuous with that of the nose-pharynx through the
eustachian tube. So you can readily understand how easy it is for an
inflammation of the throat to extend to the middle ear through the
eustachian tube.
The posterior wall which has the greatest height, reveals in its upper
portion a passage (antrum) through which the vault of the tympanum (attic)
communicates with the cells of the mastoid process, situated posteriorly.
From this description you see how near to each other these parts are
placed and when one becomes diseased the disease can extend to the other
part or parts. The brain is separated from some of these cavities by a
very thin shell of bone, and the disease can soon affect the brain through
infection or breaking through the thin structures that separates the
parts.
Diseases of the middle ear and the mastoid are always to be considered
serious, and should be very closely watched. A child with a running ear is
in danger, for it may at any time become closed up and serious.
ECZEMA OF THE EXTERNAL EAR (Auricle).--This is an inflammatory disease of
the skin, and in the poorer classes it is very frequent. It is quite a
common disease in old age. It develops in other parts of the body at the
same time in a certain percentage of cases.
Causes.--Soaps, alkalies, foreign bodies in the ear, removing ear wax and
a chronic discharge from the middle ear. There is a tendency to it in some
families; stomach trouble, improper food are also causes.
Symptoms.--Itching,--and this is very pronounced,--burning feeling. The
part is somewhat reddened, fluid oozes out, crusts form, the skin
thickens, and scales. Sometimes it swells very much.
Treatment.--Regulate the bowels, give a simple easily digested and proper
food for children and adults. Cleanse the inflamed skin gently with
castile soap and tepid water once a day. Cloths dipped in some cooling
lotion, such as the lead and opium wash, or in plain water to which has
been added a little alcohol or eau de cologne, should be wrapped around
the inflamed ear during the acute stage and they should be kept wet. Clean
vaselin, etc., is good to put on the scabs. The ear should be covered as
before directed to keep dirt, dust, etc., out.
[360 MOTHERS' REMEDIES]
HARDENED WAX OR IMPACTED CERUMEN.--This mass may be mixed with foreign
bodies or be made up of "wax" alone.
Symptoms.--A large mass of wax may remain in the ear for many years
without causing any special loss of hearing so long as the plug does not
rest against the drum and there remains a passage between the mass so that
the sound-waves can strike the drum. Generally the hearing gradually grows
less. Loss of hearing may take place suddenly, as after washing the head,
or after a general bath, or after an attempt to clean the ear with the end
of a towel. Patients will often say the dullness of hearing appeared
suddenly. This no doubt was due to the fact that the mass of wax was
displaced against the drum suddenly by an unusual movement of the head or
the jaws, or the mass became swollen through fluids getting into the
canal. If the canal is filled there will be more or less deafness, ringing
in the ear, and there may be piercing pain produced by the hardened mass,
especially if the jaws are moved from side to side. If the mass is
thoroughly and carefully removed, the hearing may entirely return if it
was caused by this wax.
Treatment.--The mass is best removed by syringing the hardened plug and
softening it gradually. Removing it with a currette and forceps without
softening it may do injury to the parts. The syringe and hot sterilized,
boiled water should be used for some time, and the patient asked
occasionally if there is any faintness or dizziness caused by it. It often
comes, in a lump after the water has been used for some time. A strong
solution of bicarbonate of sodium is also good to use.
FOREIGN BODIES IN THE EAR.--These are not of frequent occurrence. In the
case of children these bodies may comprise such objects as pebbles, beads,
beans, pieces of rolled paper, fly, bed-bug; insect of any kind may get
into ear of adults. If they reach the drum a very unpleasant sensation is
produced by the attempt to escape. Sometimes a layer of wax may gather
around the dead object. These bodies should be removed, for their presence
may produce a swelling or soreness in the canal. If the object is a dried
pea or bean the syringe should not be used. The object must be carefully
removed. Sometimes an operation is necessary to remove the object.
DISEASE OF THE MIDDLE EAR.--The ordinary cold in the head rarely runs its
course without one of the eustachian tubes at least is involved to some
extent.
SIMPLE INFLAMMATION OF THE EUSTACHIAN TUBE.--Causes.--Acute colds,
inflammation of the nose and pharynx, tonsilitis.
Symptoms.--The ear may feel full and numb, roaring in the ear may occur.
There may be pain on swallowing, shooting up through the tube.
[EYE AND EAR 361]
Treatment.--Remove the cause. Treat the nose and pharynx. Spray and gargle
with solutions advised for throat trouble. If it continues the throat
should be examined for adenoids, enlarged turbinate bones and so on.
ACUTE CATARRHAL INFLAMMATION OF THE MIDDLE EAR. Causes.--Acute coryza,
acute pharyngitis, influenza, scarlet fever, inflammation of the
eustachian tube, gargling, bathing, employing the nasal douche or
violently blowing the nose.
Inflammation of the eustachian tube is, in many cases, simply the first
stage or onset of this disease. The congestion extends beyond the tube and
involves to a greater or less degree this cavity. If it continues for a
few hours or an entire day, the watery elements of the blood will begin to
escape from the distended vessels into the tissues of the mucous membrane
and ooze out upon its free surface. If this is copious enough pressure may
be developed within the cavity, middle-ear, to cause pain. These cases
vary much in severity. In the mildest ones there may be a few twinges of
pain in the affected ear, but nothing more; and even in the most severe
cases the pain does not last longer than a few hours, although it may
return on several successive days. Very many of the earaches of young
children, from two to ten years of age, are due to this disease. The pain
is very likely to come on late in the afternoon or during the night, while
earlier in the day the child may be free from pain. In the milder forms
the condition of the drum is similar to that existing in inflammation of
the eustachian tube. It is not then much changed from normal. There may be
more congestion than in this condition. In a fairly severe case the
membrane (drum) a few hours after the onset presents a most striking
change. It is a picture of obstructed venous (dark blood) circulation of a
high degree. In some cases one or more of these distended veins may
rupture and form a blood tumor in the external ear canal. The drum is red
and more or less swollen.
Treatment.--Very little is needed for this kind, except care and watching.
Use the simple hot water in the ear carefully or poulticing when there is
pain with onions, bread and milk, and puncture of the drum if it bulges or
is too tense. Hot water for gargle, steaming of the pharynx. Keep the
patient in a room with an even temperature. The patient must not take cold
as it might extend farther.
Recovery.--The outcome is usually good in this disease if proper care is
taken; Generally in a few weeks the inflammation is gone and the hearing
is restored.
[362 MOTHERS' REMEDIES]
SEROUS MUCOUS EXUDATION INTO THE MIDDLE EAR.--The disease just described
is often associated with an (exudation) watery oozing of fluid into the
middle ear, but the following condition is different. Sometimes a
comparatively normal middle ear is found to contain a variable amount of
either fluid or mucus, or a fluid which represents a combination of both.
The failure of the fluid to absorb is due first to the fact that the
drainage through the eustachian tube is still obstructed; second, that the
absorbing process in the cavity is not acting normally.
Symptom.--Sudden change from somewhat poor to good hearing and the
reverse. It is due to the changing in the position of the fluid. The
hearing may be normal when the head is thrown far backward, for the fluid
then escapes into the antrum, or when the chin is resting upon the chest.
Another symptom that is peculiar is a feeling of something moving in the
ear. This is only felt when the head is moved suddenly. Sometimes the
patient says: "I went in bathing and got some water into my ear, and I am
unable to get it out." He thinks the water went into the ear by the way of
the external ear canal. It was due to the chilling of the surface of the
body, or the water accidentally entered into the ear through the mouth, or
nose, throat, and eustachian tube, and this caused an exudation of fluid
to take place in the middle ear. Hearing gurgling sounds in the ear during
coughing, sneezing and swallowing is an important symptom. The drum on
being examined varies greatly. The simplest case is seen when fluid
contained in the cavity is small in quantity and consists of a thin serum.
The upper level of this fluid can then be seen like a hair crossing the
drum in a more or less horizontal direction. It retains its horizontal
position when the patient moves his head backward and forward.
Treatment.--The fluid can be evacuated by an opening made into the drum,
but it usually accumulates again. The proper treatment is to treat the
diseased condition of the nose and throat, as described in other parts of
this book.
CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR.--The expression, acute
inflammation of the middle ear, is rightly employed when it is applied to
a case in which the underlying cause is of a temporary nature, as for
example, a cold in the head, and mild attack of influenza, perhaps also in
an attack of hay fever. But when the causes are of a more permanent
character and the middle ear continues for an indefinite period to be the
seat of all sorts of disturbances the combination of these different
diseased phenomena receives the name of chronic catarrhal inflammation of
the middle ear.
Causes.--Troubles (lesions) located in the upper pharynx, the
naso-pharyngeal (nose-pharynx) vault and the nasal passages. Adenoids may
cause it.
The course of this disease has of recent years been growing more
favorable, because the causes are being removed more and more.
Symptoms.--Symptoms of the acute inflammation would be present, and
impairment of hearing which sometimes comes so gradually as not to be
noticed by the patient. It will be better and then worse. A harassing,
hissing, blowing, ringing, usually accompanies it. Pains soon or later add
to the discomfort. One side is usually affected first.
[EYE AND EAR 363]
Treatment.--It must be devoted to removing the causes just mentioned.
Restore the general health. 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; and finally this assumes all the
outward characteristics of pus. In a few exceptional cases this pus fluid
will find a sufficient passage through the eustachian tube; but in the
great majority of cases this passageway becomes closed almost at the very
beginning of the attack, and then the free exudation; under an ever
increasing pressure and on account of the softening and breaking down of
the tissues of the drum forces an opening for itself directly through the
drum membrane.
Causes.--The same causes that produce the acute variety will produce this
variety of the disease. It occurs more frequently during the spring and
fall months as the result of changes in the climate. Acute and chronic
catarrh of the nose and pharynx are causes. It frequently occurs in
connection with scarlet fever and measles. It complicates nose and
pharyngeal diphtheria.
Symptoms.--Pain in the ear is the most striking symptom noticed by the
patient. In infants and young children of two or three years of age it may
appear and not be recognized until a slight discharge appears at the
opening of the external ear. The child is feverish, fretful and peevish,
seemingly suffering great pain, and the parents think it is, not very sick
or has only an earache. Sometimes physicians fail to recognize the trouble
until the discharge appears in the external ear. The symptoms are more
severe at night. Any physical or mental exertion increases the plain. The
pain is sometimes very severe, and a spontaneous or artificial rupture of
the drum eases the suffering very quickly in some cases, and a bloody,
serous, pus-like discharge escapes into the external ear canal. Often a
patient will say: "I felt something give away in the ear, a watery
discharge appeared, and the pain soon subsided." In many cases the rupture
of the drum gives little or no relief from suffering. This is due in some
cases to the small and insufficient size of the opening in the drum. If
the pain persists, after a free opening has been made, it may indicate
that pressure exists in some cavity or cavities other than the middle ear
proper. A sensation of fullness and sometimes of throbbing or pulsation in
the affected ear; roaring, singing, whistling, etc.; impairment of
hearing; increased pain, when the jaws are opened and shut, are symptoms
of minor importance. If there are no complications after free discharge
sets in the pain disappears, the fever gradually returns to the normal
point, and the patient drops to sleep. In the course of a week or two the
discharge subsides and if the rupture is not too extensive the wound will
close and the patient will soon be well. Frequently, however, on account
of disease of one or more of the bony parts, the wall of the middle ear or
the mastoid cells, the discharge continues for weeks and may become
chronic in its character.
[364 MOTHERS' REMEDIES ]
Treatment.--Apply heat or cold first. Open the bowels.
How to apply heat.--With the patient lying on his side with the affected
ear turned upward, fill the external ear canal with hot water (about 105
degrees F.), then place immediately over the affected ear a hot flaxseed
meal poultice, five or six inches square and one-half inch thick, and
spread a folded blanket or shawl over the whole to keep it warm as long as
possible. Bread and milk with catnip, or onions will do if flaxseed is not
at hand. The flaxseed holds the heat longer. Water is a good conductor of
heat, and that which fills the external auditory (ear) canal may rightly
be considered as an arm of the poultice which extends down to the drum
itself.
Leeches also can be applied in front and below the tragus (front of the
opening). If the symptoms do not improve under this treatment and
especially if the drum is bulging, an opening should be made at the
bulging point of the drum. The canal is now syringed with a warm
antiseptic solution--like one part listerine, etc., to twenty parts of
warm boiled water, with a clean syringe, or warm boiled water can be used
alone. If there is any odor carbolic acid one part, to fifty or sixty of
water can be used. A strip of sterile gauze is put into the canal for
drainage and protection. This syringing can be done from two to four to
five times a day, and gradually decrease the number of times as the
discharge lessens. It must be syringed and dressed often enough to allow a
free discharge and produce cleanliness.
Recovery.--The result of this disease cannot be told at the outset. The
majority of such attacks end favorably, with care and treatment; this in
persons of good constitution and health. It may run ten days to three to
six weeks. In tuberculous patients the result is not so favorable.
Recovery follows as a rule in this disease following scarlet fever and
measles, but not so quickly, and there may be a discharge for some time,
due to chronic disease of the ears, etc.
Complications and results.--In the majority of cases, in ordinarily
healthy persons, this disease runs its course without doing any great
amount of damage to the organ of hearing, and without involving any
structure lying outside of the middle ear proper. In scarlet fever,
measles, la grippe, or nasal diphtheria, actual destruction of tissue
often takes place in some part of the middle ear before it is recognized.
Sometimes it results the same way even when it is discovered in time.
Caution.--A person who has had this disease should be very careful not to
take cold. The patient should take plenty of time to get well and strong.
The diet should be liquid mostly.
[EYE AND EAR 365]
CHRONIC SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.--An inflammation that
forms pus; hence called suppurative. This is an inflammation that has
become chronic (continued) and has one characteristic at least that is
very noticeable, and that is the discharge. This may last for an
indefinite period. The acute suppurative (pus-forming) inflammation just
described in the foregoing pages, may have inflicted various kinds and
degrees of damage upon the mucous membrane which lines the cavities, and
as a result of the conditions thus established there will be a discharge
which may last an indefinite time.
Causes.--Improper or lack of treatment for the acute suppurative
inflammatory attack. This is the chief cause. The first attack may have
been caused by scarlet fever, measles, etc. They are prone to become
chronic, especially if not recognized early and treated properly.
Symptoms.--The main symptom is the discharge from the ear. This may be
abundant or scanty. It may stop for a time and begin again. The hearing
may be slightly or seriously impaired. Such patients are not accepted by
life insurance companies.
Treatment.--Cleanliness of the parts and perfect drainage must be secured.
Syringing with one to fifty carbolic acid solution (acid one part, warm
water fifty parts) is good treatment. The opening in the drum should be
made large enough to give free discharge to the pus in the middle ear.
The patient's strength must be built up if necessary.
INFLAMMATION OF THE MASTOID' CELLS. (Acute or Chronic Mastoiditis).--This
disease represents one of the most serious terminations of an acute or a
chronic suppurative inflammation of the middle ear. This is fortunately a
comparatively rare event. There are, however, quite a good many cases of
this terrible disease.
Causes.--It occurs as a primary or secondary disease. The first condition
is rare and the result from injury, exposure to cold and dampness, or from
syphilis or tuberculosis. Secondary disease is catarrhal or pus-like in
form. This results from an extension of middle ear disease through the
antrum, as a rule. The disease may develop at any time and endanger the
life of the sufferer.
Symptoms.--Dull constant pain behind the ear and tenderness on pressure,
more severe at night, the tenderness is very apt to be followed in a short
time by redness and swelling of the skin in the same region. The pus may
drain from the mastoid into the middle ear cavity. If this does not happen
it may swell behind the ear and break through some other place. It may
involve the structures within the brain. If meningitis develops, the
patient has headache and later it becomes very severe. Lights hurts the
eyes, The patient is restless, sleepless, may have nausea and vomiting and
a constant high temperature. The neck is stiff and rigid. If there is more
brain involvement (phlebitis) there will be sudden rise of temperature,
followed by a rapid fall of temperature and attended by profuse sweating
and chills,--a dangerous condition. There can be abscess of the brain
also. In abscess of the brain symptoms are less severe and localized; the
rigid neck and fear of light and vomiting are absent.
[366 MOTHERS' REMEDIES ]
Treatment.--If seen early it may be aborted. If an examination of the drum
shows bulging, an incision of the drum head should be made. If an opening
is there it should be enlarged, if necessary. Cold applications are
valuable and should be applied directly over the mastoid behind the ear.
Sometimes hot applications are better, hot poultices, cloths, etc.,
syringing the canal with hot water. These applications, etc., should be
constantly used for a day or, so, unless unfavorable symptoms set in, when
if a marked improvement, especially in the local tenderness and pain, has
not occurred, an operation should be done and the mastoid opened.
The diet should be liquid (milk), nourishing and sustaining. Bowels should
be kept open.
This disease must be carefully watched. It is not only dangerous to life,
and very quickly, but it is full of disagreeable and dangerous
possibilities, lifelong discharge from the ear, an external fistulous
opening, a permanent paralysis of the facial nerve, abscess in the brain.
Brain symptoms, paralysis and pus symptoms do not now preclude an
operation on the mastoid for mastoid disease. The patient should be
closely watched and an operation performed as soon as called for.
I have given a longer description of the diseases of the ear than I
intended when I began this part of the work. Diseases of the ear are
becoming quite frequent, and the subject is important. I did not give much
general medical treatment because I consider the local treatment is of
more importance in a work of this kind. In treating the baby, I shall give
more medical treatment. I shall treat the disease also, especially in
relation to the baby. There can be more local applications used than those
given. If the hot treatment is thought best, not only hot water and
poultices of many kinds can be used, but fomentations of hops, etc., and
hot water cloths alone. The intent of such treatment is to keep hot moist
applications to the part continually. The use of laudanum in poultices
used for ear trouble is not recommended because its soothing power may
obscure symptoms that might appear and be dangerous in themselves and need
quick and thorough treatment. The syringing of hot water into the external
canal is often of great help. Five to ten grains of boric acid can be used
in an ounce of water. If there is much odor to the discharge, you can use
one part of carbolic acid to fifty parts of boiled water. The water should
not be used too hot. One teaspoonful of the acid to fifty teaspoonfuls of
water, or that proportion. After using the hot water, the canal should be
filled with gauze for protection and drainage. For the fever, the first
twenty-four hours, one-tenth to one drop of aconite can be used every one
to three hours. By putting one drop in ten teaspoonfuls of water you get
one-tenth of a drop at a dose.
[EYE AND EAR 367]
DEAFNESS.--This is usually the result of a disease and is merely a
symptom. Diseases of the middle ear, rupture of the drum membrane, and
large ulceration of this membrane cause it. Ear wax causes temporary
deafness. Diseases of the throat and nose cause it very often, and
deafness frequently accompanies catarrh of the nose. Adenoids cause it
sometimes, especially in children.
Treatment.--The only way to prevent this trouble is to treat the disease
that causes it. Discharge from the ear, due to ear disease should be
treated from the first or it may cause permanent deafness in that ear.
Many cases of scarlet fever leave deafness behind in one ear at least.
This trouble should be closely watched during an attack of scarlet fever,
and in other infectious diseases and proper treatment given.
Chronic deafness is hard to cure; so often some of the deeper parts of the
ear are diseased. When a person recognizes that his hearing is growing
less acute he should have his ear examined. People often let the trouble
go too long before beginning treatment.
MOTHERS' REMEDIES. Deafness. 1. Quick and Effective Remedy for.--"Five or
ten drops of onion juice put in the ear several times a day is very good.
If there is any pain in the ear, add a drop or two of laudanum, or you may
just use two or three drops of glycerin with the other ingredients. In
about an hour after treating the ear in this manner, syringe it well with
warm castile soap suds or warm milk."
2. Deafness. Often Tried Remedy for.--"Take one dram each of tincture of
lobelia, tincture of gum myrrh, oil of sassafras, tincture of opium and
olive oil, mix and apply lint wet with the liniment in the ear, night, and
morning, then syringe out with warm water and castile soap."
3. Deafness, My Mother, in Galt, Found Mullein Good for.--"Small blossoms
of mullein, fill bottles and cork, hang in sun till oil forms, drop three
drops every third day in the ear for three or four weeks. We tried this
successfully in our family."
EARACHE.--The general belief exists that earache is something which is
quite harmless and entirely different from a genuine inflammation of the
ear. This belief is strengthened by the fact that the great majority of
earaches subside without inflicting any harm upon the ear. As soon as a
discharge appears, in many cases, there is relief. If a discharge appears,
the earache was the result of an inflammation in the ear. So-called
earache lasts but a short time, and can be relieved by either hot or cold
applications; but when the earache continues for a day or more it is an
indication of more than pain in the ear and if a thorough examination is
made there will, no doubt, be found disease of the ear that is causing the
earache. Then the disease proper should be treated.
[368 MOTHERS' REMEDIES]
Treatment.--Hot or cold applications are of benefit. With the patient
lying upon the well ear, fill the canal with hot water (105 degrees F.).
Then place over the ear a flaxseed poultice or a roasted onion poultice,
four to five inches square and one-half inch thick and spread over all a
folded shawl. Bread and milk makes a good poultice also. A hot bran bag or
a hot salt bag is good. The heat must be continuous.
MOTHERS' REMEDIES. 1. Earache, Hot Raisin for.--"Hot raisins sometimes
relieve earache. Soak them in hot milk and change frequently." This is an
excellent remedy. The raisins should be placed in the ear canal, and they
are sure to give relief.
2. Earache, Flax and Cornmeal for.--"Flaxseed and cornmeal in oil." Take
equal parts of flaxseed and cornmeal and mix together, then add enough
sweet oil to moisten this mixture. This should be applied hot and kept so
by repeating as each poultice is cold. This will be found very beneficial.
3. Earache, Soothing Home Remedy for.--"Glycerin and laudanum heated and
dropped in the ear. Hot poultice of hops inclosed in cotton bag and
applied to the ear is very soothing." The glycerin and laudanum will give
temporary relief and the hops poultice retains the heat, which is one of
the essential things in earache.
4. Earache, Horse-radish Leaves for.--"Steaming the face and ear with
crushed horseradish leaves will give relief and soothes one to sleep."
When through steaming the face the horseradish leaves should be applied to
the face and ear as a poultice. This is very soothing.
5. Earache, Onion Sure Cure for.--"The heart of an onion." Roast the
heart of an onion and put in the canal of the ear. Then apply heat to the
outside of the ear and relief will soon be obtained.