12. Diseases of the External Meatus.
ECZEMA appears commonly behind the ears, but also invades the auricle, and not unfrequently extends to the meatus. Not unfrequently there also exists a chronic suppuration from the middle ear, which may be the cause of the eczema. When this extension takes place there is some degree of deafness, in addition to the great smarting and itching which characterize the disorder. The general causes and symptoms are similar to those of Eczema when it occurs in other parts of the body.
TREATMENT. Belladonna, or Puls, for the smooth variety; Rhus or Verbascum Vir. for the vesicular; Graphites for Eczema behind the ears; and Arsenicum or Sulph. for chronic cases.
ACCESSORY TREATMENT.- Keep the ear clean by syringing and careful drying; dust the part with flour or finely powdered starch to soothe irritability, and to absorb any fluid that may exude. Daily soft water baths for the general surface of the skin, the use of small quantities of uncooked vegetables, such as lettuce, watercress, celery, etc. and the correction of any derangements of digestion and assimilation will favour the cure of Eczema. Erysipelas, and other cutaneous affections of the ear, as they do when these disease affect other portions of the skin.
Cerumen, or ear-wax, is composed of oil, stearine, a little coloured matter, scales of epidermis from the lining of the meatus, and other substances. It contains only about 0.1 per cent. of water, and is only very partially soluble. After remaining for sometime in the canal, its watery constituent passes off by evaporation, and thus it becomes a hard mass. In advancing age, the cerumen seems to contain less proportion of water than during the earlier periods of life, for it becomes drier and more brittle. The function of the ceruminous glands which secrete the wax seems to be to eliminate a product which will render the canal pliable, and perhaps also prevents the entrance of insects.
An accumulation of wax may be caused by the too zealous attempts of the patient to keep the ear clean the wax being forced into the narrow deeper part of the canal.
SYMPTOMS.- The chief symptom of impacted wax is deafness, which is often of sudden onset. Impaction of wax causes deafness only when the lumen of the auditory canal becomes completely occluded by the plug. Noises and giddiness are sometimes present. Pain is occasionally complained of, and is usually due to the pressure of the plug upon an inflamed area of skin. Certain reflex symptoms such as coughing and sneezing have been met with.
Diagnosis is best effected with the head mirror and ear speculum.
TREATMENT.- The wax is best removed by a careful use of the syringe, throwing a small jet of water, at the temperature of full blood heat, along the roof of the meatus. If the water be too hot or too cold it will cause giddiness. If pain ensue, the syringing should be discontinued. In syringing, the ear should be seized with the thumb and finger of the left hand, and pulled gently upwards and backwards as far as it will go, thus straightening the meatus. A few drops of warm almond oil, or glycerine, or warm solution of soda (ten grains of soda bicarbonate to one ounce of water or glycerine) put in the ear at night will soften the wax and facilitate its removal. To ascertain the progress of removal, the ear should be frequently examined with the speculum.
ABSENCE OF WAX. -Sulph., Graphites, or Spongia, will be found remedial.
FURUNCLE, OR ABSCESS OF THE MEATUS.
This is a very common, painful, and somewhat serious disease, to which some persons seem peculiarly liable. It is often associated with boils in other parts of the skin. The frequent recurrence of abscesses causes thickening of the walls of the meatus and of the drum, and if the tendency to them is not eradicated some degree of deafness is an invariable result. They are always exquisitely painful, and produce very decided tenderness round the ear. They are liable to recur.
SYMPTOMS.- Acute throbbing, darting pain in the meatus, great tenderness, tense swelling, temporary partial deafness, consequent on obstruction of the canal.
TREATMENT.- Belladonna.-Local redness; headache; flushed face; throbbing. If taken promptly, on the first appearance of inflammation, this remedy will often prevent the formation of the Abscess.
Mercurius Sol.- This is appropriate before suppuration sets in, and may be alternated with Belladonna
Silicea.-If Belladonna does not prove arrestive, this medicine will often succeed.
Hepar-Sulphuris.-If the abscess be formed, its suppuration will be facilitated by this remedy, and its extension within the meatus prevented.
Sulphur.- This should be given after the resolution of the abscess to prevent re-formation, and to correct the constitutional diathesis.
ACCESSORY TREATMENT.- A free use of fomentations and poultices as hot as can be borne will relieve the acute pain often experienced, and hasten the formation of matter. The abscess should be opened early, as soon as the throbbing indicates the formation of matter, the tissues are so dense here, and spontaneous rupture is a long and very painful process, and the bone may become carious. When Belladonna is given internally to mitigate pain, a topical application will be serviceable. A little piece of lint may be moistened with two or three drops of the tincture, and introduced into the ear. Subsequent cold must be averted by avoiding draughts after fomentation, and by insertion of cotton-wool in the ear. The latter is desirable for the absorption of the suppurating matter, but should be frequently changed, lest, by drying, the wool should increase the irritation.
128. Disease of the Tympanum.
ACUTE OTITIS MEDIA.
Usually arises in connection with septic conditions of the throat and naso-pharynx. It varies considerably in its severity, and may run a mild or a severe course.
SYMPTOMS.-Pain in the ear, deafness, and certain degree of fever. In children the symptoms may stimulate those of meningitis. The sudden cessation of pain and the appearance of a discharge from the ear indicate perforation of the membrana tympani.
CAUSES.- Naso-pharyngeal catarrh, which extends through the Eustachian tube to the tympanum. In the latter manner the ear becomes implicated in course of the various exanthemata. The disease may also be coincident with affections of the skin, or mucous membrane in other parts of the body; these causes are especially operative in weak and neglected children.
TREATMENT.- Aconite (early stage of Inflammation); Belladonna (congestion; cerebral symptoms); Pulsatilla (inflammation following Measles; darting, tearing pains); Mercurius (pains extend to the teeth, and are worse in a warm bed; following Small pox); Chamomilla (excessive, almost unbearable pain); Sulph. (convalescence).
ACCESSORY TREATMENT.- Pain may be allayed by repeated instillation into the ear of a few drops of cocaine and carbolic acid in glycerine (five grains of each to a drachm of glycerine). A few drops of laudanum hot boracic installations, or the application of a dry hot sponge may prove soothing. After rupture the meatus must be kept clean. Attention must be paid to any affection of the throat or nose that may be present.
SUPPURATION IN THE MIDDLE EAR.
This is the source of all chronic discharges from the ear which were formerly classed as Otorrhoea. Acute suppuration may pass into the chronic variety, which is characterized by a perforation of the tympanic membrane, a persistent purulent of the tympanic membrane, a persistent purulent or muco-purulent discharge from the middle ear, and a certain amount of deafness.
There are various serious complications, to which a person who is the subject of chronic discharge from the ear is liable, and measures should be taken to cure it as soon as possible.
TREATMENT.- Mercurius.-Thick, bloody, and foetid discharge, accompanied by tearing pains in the affected side of the head and face, and swelling and tenderness of the glands about the ear. Also when the disease has followed Small-pox.
Hepar Sulph.-Discharge of pus and blood; and when the patient has been dosed with Mercury.
Capsicum.-An especially valuable remedy. It seems to have a specific relation to the ear, and is often curative, even when the mastoid cells are implicated (Haughton).
Pulsatilla-Discharge of a thin watery character, or purulent, and when it follows Measles or Mumps. K-Bich. is indicated by similar conditions.
Ac-Mur.- A remedy of great value in affections of the ear consequent on Scarlet fever; or Eczema, with burning itching.
Arsenicum.-Excoriating discharge in feeble constitutions.
Causticum.-Otorrhoea with eruptions behind the ears and about the nose in tubercular subjects.
Calcarea and Sulphur.-Tedious cases; and tubercular patients; the former may by administered morning and night for a week to be followed, after a couple of days’ interval, by the latter.
Ac-Nit., Iodium, Aurum, Merc-Iodium, Silicea, K.-Hydriod, or Tellur., may also be required in some cases.
Electricity has been successfully employed.
SURGICAL TREATMENT.-Should the disease not speedily yield to remedies, paracentesis of the drum should be performed. When grave brain symptoms accompany evident of the mastoid cells, trephining of the process should be early resorted to. No fear need be entertained lest an artificial perforation of the drum may not heal. The difficulty lies in preventing its healing before the disease is cured. In fact, to avoid this difficulty, the operation must at time be often repeated. Even spontaneous ruptures heal rapidly. Only in neglected and chronic cases, where the aperture is large, does it remain open.
Nor, if the inflammation be cured, is a rupture of great detriment to the hearing. In fact, where the membrana tympani is thickened from chronic inflammation, paracentesis often improves the acuteness of hearing very decidedly.
When the discharge is abundant the practice of plugging the ear with cotton, or wool, is a bad one, since it tends to confine the pus, which should have free exit. Keep the parts clean by frequently syringing with antiseptic lotions. Instillation of peroxide of hydrogen solution (one in twenty) followed by syringing with boiled water or boracic lotion, once, twice, or thrice daily, according to the requirements of the cases. Poultices and fomentations are of no service, and are dirty and disgusting. Relief from pain is best given by the local application of Aconite and Morphine. It should always be warmed before it is used.
GENERAL MEASURES.- The intractable character of this affection is often, in great measure, due to the neglect of that strict cleanliness which is so necessary to be observed. The irritating discharge, if allowed to accumulate within the meatus, undergoes decomposition, and gives rise to changes in the deeper structures of the ear, the nature of which may be inferred from the irritation and excoriation so often existing in the external orifice. A little fine wool, lightly introduced so as not to cork in the discharge, frequently changed, may be put into the ear when the discharge is declining, to protect it, out of doors, in cold weather; but even this should be done with great caution, particularly when the discharge smells offensively, for nothing can be more prejudicial than stopping the ear with cotton-wool to prevent its escape. To correct the foetor of the discharge, which is often very great, a weak lotion of Condy’s Fluid, or better still of peroxide of hydrogen, should be injected. All fluids injected into the ear should be warm.
Carbolic Acid lotion is also of great value in Otorrhoea. The following are the proportions in which it may be safely prescribed-
Carbolic Acid 3j.
Distilled water z3v. m.
The improvement of the general health of the patient is a point of great importance; for this purpose, change of air, and, in the autumnal months, sea-air, is often attended with most beneficial results. In the absence of sea-air, country air, in a bracing district, is of great advantage. Cod-liver oil is also strongly recommended.
It is a very common and very foolish idea, which has been fostered in the minds of the laity by ignorant or indolent physicians, that it is dangerous to cure a discharge from the ear. It is doubtful whether a single instance of evil results, under wise treatment, can be cited. Of course irritating lotions too often repeated may set up an acute. Otitis based upon the chronic condition, but it very rarely happens; but the idea that the ear in these cases serves as a vent-hole for peccant humours is worthy only of the pathology of the dark ages. The continuance of this disease not only makes the patient a filthy and disgusting nuisance to himself and all around him, but it often greatly endangers life itself. True, where any dyscrasia exists the appropriate specific should be used internally, but an ulcer here can be as safely healed as anywhere on the body, and if not healed incurable deafness of a high degree is certain to follow.
VARIETIES AND CAUSES.-
(a) Functional or nervous Deafness.-This variety depends upon constitutional debility; the same conditions which weaken and relax the general muscular and nervous systems act injuriously upon the ear. Functional Deafness is painless; it is better when the digestive organs are unimpaired, the spirits exuberant, and the weather fine.
(b). From disease.- Under this head we may mention-organic changes in the brain; obstruction of the internal ear; Ulceration and Perforation of the tympanum; Paralysis of the acoustic nerve; various acute or chronic inflammatory affections, and disease of the throat (Throat deafness).
(c) Deaf-dumbness.-This is due to congenital malformation of the ear, and is irremediable.
Other causes are-the application of cold; sudden loud noises; blows on the head, as boxing a child’s ears, or fracture, which lead either to Concussion or Rupture of the auditory nerve; swelling of the lining membrane. Accumulation of hardened ear- wax, exfoliated scarf-skin, or other substances lodged in the ear-passage, may cause deafness by obstruction. The Deafness that results from Catarrh is often but an aggravation of pre-existing Deafness-all the share the Cold has in the production of the disease being that of reducing the hearing power a little further, and so rendering the defect more obvious.
PROGNOSIS.-In forming an opinion as to the chances of recovery, or of amelioration, the following circumstances should be duly taken into account-age of the patient; hereditary tendency to Deafness, or the association of the malady with any constitutional disease, or with cerebral symptoms, or with the nervous temperament. If a patient comes to us with deafness who has suffered from enlargement of the Tonsils, chronic Catarrh, Rheumatism, Gout, or secondary Syphilis, our hope of a favourable result will be greatly diminished. Deaf persons sometimes state that they can hear well under exceptional circumstances, as in the noise of a railway carriage, a crowded thoroughfare, or amidst the whirl of busy machinery; these and similar sounds, which suspend the hearing of healthy persons, furnish such a degree of abnormal stimulation as to excite the dull nerve to unwanted quickness of hearing. The inference from this unhealthy condition of hearing must be regarded as unfavourable for the prospect of recovery.
TREATMENT.-The cure of Deafness of course depends on the removal of the cause; in many cases this is practicable; in some it is not. In most cases, however, skilful treatment is successful, and it is very rare indeed after a course of homoeopathic remedies for a patient not to find his hearing power decidedly and permanently stronger. Recent cases are of course most hopeful. But long-standing cases, even when both ears are affected, are generally benefited to a greater or less extent.
EPITOME OF TREATMENT.-
1. From debility of constitution, etc.-Phosphorus (nervous); Chin- Sulph. (nervous and periodic); Iodium, Ac-Phosphorus, Cact. (with Palpitation); Petrol. 3x, Spongia, Arsenicum
2. From cold.-Aconite, Pulsatilla, (recent); Mercurius, K-Hydroid. (chronic); Dulcamara (from damp); Bryonia (with Rheumatism).
3. After fevers, etc.-Belladonna (with giddiness); Pulsatilla, China, Sulphur, Ac. Phosphorus
4. From suppressed eruption about, or discharge from the ear.- Sulph., Hep-S., Aurum
5. From enlarged Tonsils, etc.-Merc Iodium, K-Hydriod., Mercurius- Cor., Iodium
6. From Concussion.-Arnica (also when deafness is accompanied with a crawling sensation in the ear).
7. Noises in the ears (Tinnitus aurium).-Belladonna, China Sulph., Nat-Salicyl. (with deafness); Nux V. or Ignatia (with unnatural sensitiveness to sound); Baptisia roaring, confusion of mind, dullness of hearing); Gelsemium
ACCESSORY MEANS.-If Deafness be found to arise from an accumulation of hardened ear-wax, this should be removed by the syringe and warm water. All reputed remedies which have to be dropped into the ear should be eschewed, however much they are recommended See also General Hints, following.
GENERAL HINTS ON AFFECTIONS OF THE EAR.
(1) Wet or damp ears.-After bathing, care should be taken to dry the head and ears thoroughly.
(2) Boxing the ears.-Parents, governesses, and others who have the care of children, should be aware of an accident very liable to occur from blows on the head or boxing the ears, namely, rupture of the membrana tympani, a membrane which closes the bottom of the meatus, and is stretched something like the parchment of a drum. The accident may be recognized by a sense of shock in the ear, Deafness, and a slight discharge of blood from the orifice; and if examined by an ear speculum, the rent may be seen. There should be complete rest for several days, and a weak Arnica lotion used.
(3) Deafness not stupidity.-Another point of considerable importance is the case in which a child, from being slightly deaf, has been thought to be stupid or obstinate. Very sad it is to think how often a child is thus punished for his misfortune, and it may be irremediable injuries inflicted on the mind or temper of this poor victim of unintentional injustice. It is hardly necessary to insist upon the care which is requisite in examining the state of the hearing power in a child, or to refer to the fact that children will often say, and doubtless think, that they hear a watch when they do not (J.C. Foster).
(4) Dilutions of the medicines.-In all chronic affections of this organ, the higher dilutions of the different medicines are generally more efficacious than the lower.