From a study of 600 cases of middle ear disease the following conclusions have been reached:— 1. Sclerosis of the middle ear is usually tbe result of previous nasal or pharyngeal disease.
2. Otitis media suppurativa is a com mon and frequent result of acute or chronic naso-pharyngeal disease.
3. Fully 75 per cent. of all forrns of middle-ear disease will show on examina tion or give a history of naso-pharyngeal disease.
4. Sixty-four per cent. of tympanic affections are coincident with patholog ical changes either in the nares or phal ynx or both.
5. Sclerotic or atrophic changes of the naso-pharynx are of little consequence in the production of deafness as compared with chronic hypertrophy or any morbid change producing congestion of the nose or throat.
6. Of nasal affections, hypertrophy of the turbinals is the most potent factor in the production of aural disease.
7. Aural affections are more frequent in hypertrophies of the post-nasal space or naso-pharynx than in either pure nasal or pharyngeal disease.
8. The effects of passing disease of the nares or pharynx in the production of middle-ear disease is of much importance.
9. General diseases, such as measles, with local naso-pharyngeal manifesta tions, exert a marked causative influence in the production of middle-ear disease.
10. To a great extent the successful is sue of aural disease depends upon ap propriate naso - pharyngeal treatment. L. S. Somers (T_Tniv. Med. Mag., Aug , '97).
Symptoms.—The onset of this form of otitis is gradual; hence it has been called chronic progressive hardness of hearing. After an attack of acute ca tarrhal congestion of the middle car the ear may not return to its normal state, but remain the seat of more or less tin nitus and of a stopped feeling. The litating at first is but little impaired, hith lt-ads the patient to disregard his tar disease, thinking it will pass off, t-pteially if the impediment is confined to one tar. I lowever, with every cold in the head the ear feels worse and after tacit told the noises in the ear and the hardness of hearing increase and are no ticed more and more by the patient and his friends. As the symptoms of tinnitus and &illness increase there may be added attacks of ear-vertigo—sometimes called Menire's disease. These attacks come
on suddenly, occurring once or twice a rear at first, and are -usually not referred to the ear as a cause either by the pa tient or his physician. In fact, they are :t.mmonly considered and treated as at tacks of stomachic vertigo or neurasthe nia. In some instances the attacks of car-vertigo are preceded by an increase in the tinnitus aurium, and this may arouse in the patient a suspicion that the ear disease is the cause of his vertigo. When chronic ear-vertigo sets in, it is in the later stages of chronic catarrhal deafness, and the deafness is generally iTofound in the car or ears affected. In every case of chronic catarrhal otitis media there is, very early in the process, contraction of the tensor tympani, re traction of the chain of auditory ossicles, and consequent impaction of the stapes in the oval window. It is this last event that causes compression of the intro. labyrinthine fluid, irritation of the motor filaments of the auditory nerve and cere bellar peduncles, with reflex phenomena uf vertigo.
If these attacks of ear-vertigo once set in, they gradually increase in frequency frem once in six months to once a month and finally once a fortnight. As the pa tient suffers from nausea and vomiting, as well as inability to walk steadily, or even at all, and as be may be seized by vertigo and reeling in the street and mis taken for a drunken man, he is unwilling to leave the house alone. His business is interrupted, his nervous force gives out, and his general condition becomes deplorable. Unfortunately, he is often treated now for "neurasthenia," "epi lepsy," and even "apoplexy" instead of The fact that a patient with ear-vertigo never loses consciousness in his attacks serves to render the differ ential diagnosis positive.
Treatment.—Since chronic catarrhal otitis media is caused by chronic hyper trophie catarrh, and not by throat disease, the naso-pharynx must receive the first attention and the general health improved—if irnpaired, as it generally is. The treatment of the nares must be non-irritant, otherwise the ear disease will get worse. Oleaginous sprays are much better than watery sprays, since the former clo not "water log" the tissues like the latter.