MIDDLE EAR, DISEASES OF.—Over GO per cent. of all ear diseases are in the middle ear. Afore adults than children (3 to 1) and more men than women are affected with diseases of this part of the organ of bearing.
Diseases of the middle ear are divided into four general classes; viz.: acute ca tarrhal, chronic catarrhal, acute purulent, and chronic purulent otitis media. All these begin as an acute catarrhal process, influenced, of course, by special condi tions of health and diathesis in the pa tient. As a rule, the acute catarrhal process of the middle ear originates in an acute catarrh of the naso-pharynx and the Eustachian tube, whence it spreads to the middle ear, which in its normal state is an aseptic cavity. Sometimes it seems that the entrance of cold water, cold air, or some other irritant into the external auditory canal sets up an inflam niation in the middle ear; but in such cases it will be found that the naso pharynx was more or less inflamed and supplied the pathogenic germ to the drum-cavity, congested from disease in the external ear, thus supplying a soil favorable to the growth of streptococci or other pathogenic organisms.
Acute Catarrhal Otitis Media.
Symptoms.—The earliest symptoms of this disorder are a sensation of stuffi ness in one or both ears and hissing or pulsating tinnitus, but without pain and altered hearing. Sometimes, indeed, in the early stages the hearing may be hypercesthetic. Most of us experience this mild stage of acute catarrhal otitis media with a cold in the head. As simple coryza passes off, all ear symptoms go with it, if the local treatment of the nares and naso-pharynx has been mild and gentle, or purely negative. If the conditions in our own naso-pharynges and middle ears are closely observed when we have coryza we shall notice that, as secretion increases in the naso pharynx (but not before), the Eustachian tube ceases to open at each act of swal lowing as it does in a normal state. The ear may feel more or less stopped, and now and then there may be slight pain running into it from the posterior nares.
If in these- early stages the naso-pharynx, nares, and Eustachian tube receive no local treatment or only a mild one with a bland, oleaginous spray, we shall per ceive that, as secretion in the nares and naso-pharynx diminishes, in the course of from three to six days, the Eustachian tube will open spontaneously (or with an act of swallowing) and the ear will feel clear once more. This stoppage of the Eustachian tube in the early secretory stages of an acute coryza is beneficial, since it is _Nature's seal set against the entrance of pathogenic germs from the naso-pharynx into the normally aseptic middle ear. If this seal is broken, either by forcible blowir,g of the nose, Valsalvau autoinflation, or the inflation-bag of the surgeon it is done to the injury of the patient, as pathogenic germs are very lik-ely to be forced by such manipulations from the naso-pharynx into the middle ear and an acute purulent inflammation of the drum-cavity set up. Acute catar rhal otitis is as common as acute coryza, and as simple if properly managed; but the transition to acute purulent otitis, a serious malady, will be rapid if the local treatment of acute catarrhal otitis is in judicious.
Diagnosis.—If the membrana tympani be examined in the early stages of a sim ple acute otitis, it will be seen to have undergone very slight, if any, change. It may look a little pink or even red along the malleus and periphery. But its general surface undergoes no change in appearance or position.
Otitis is very frequent in the newborn and in suckling's. In 47 infants there were 37 cases of otitis,—bilateral in 23 instances. The appearances NI ithin the ear in this affection are infiltration and redness of the drum-head, often a pro jection of the posterior half of the mem brane, and disappearance of the apophy sis. doubtfill cases an exploratory puncture should be made.