Vertigo can be divided into four varie ties. viz.: (1) vertigo ineident to dis ea:se, of the heart. (2) vertigo compli cating diseases of the stomael, and intestinal tract, (3) vertigo associated -with diseases of the eye, and (4) vertigo dependent upon diseases of the ear. Vertigo associated with ear diseases is almost always associated with tinnitus. When there is moderate deafness. vertigo is not usually complained of. Vertigo due to aural disorder either subjective or objective. and the vertigo varies from &light giddiness to an inability to Tstand up or walk. The vertigo is usually re ferred to the .side on which the lesion exist4. The first etTort should be to strike at the root of the disorder by re storing the lumen of the Eustachian tube. The most rapid and etreetive measure of accomplishing this is by elec trolysis. The smallest bougie with a tip 1 millimetre in diameter is preferred for the first treatment, and a current of from twenty-five to forty volt:. and from 2 to 5 milliamperes should be used. Electrolysis, and not cauterization, is desired. The negative pole should be attached to the bougie, and the positive eleetrode held in the hand. Before pass ing the bougie the mouth of the Eu stachian tube should be thoroughly ameAthetized with eoeaine. To be ef feetive the tip of the bougie should pas7-] within the tympanie cavity. and infla tion -thould not be done for forty-eight hours. \V. P. Brandegee (Laryngoscope, Feb.. 1902).
Chronic Purulent Otitis Media. — Chronic purulent otitis media is due to the permanent lodgment of staphylococci in the acutely-inflamed middle ear. This unfortunate result is usually brought about by improper treatment of the acute otitis media, generally by the patient, but sometimes, it must be admitted, by his physician.
Analy:lis of 300 eases ot suppurative otiti, media chronica. Of these 300 cases, 72, or 24 per eent., resulted from scarla tina ; 27. or 9 per cent.. followed measdezs. ; 37 eases were due to nao-pharyngeal ca tarrh; 4 cases resulted from blows on the ear; 11 cases ori;:rinatecl durim, the first dentition; 7 cases were due to tubercular disease of the mucous membrane; 3 cases developed after the entrance of salt water into the ear; 1 case originated during an attack of pertussis; 137 cases arc recorded as resulting from "colds in the head." Alilligan Uhronicle, Sept., '9I).
Symptoms. — The symptoms of this condition are objectively a perforated membrana and more or less copious and offensive discharge from the ear. This hole in the membrane varies from the size of a pin's head to that of the entire mernbrana.
The membrana loses its lustre first, and sooner or later becomes thick and red, denuded and secreting. When the perforation is large all the ossicles may be visible. Or the malleus, the manu brium being partly destroyed by caries, may be the only one visible. The incus is generally the first to go in part or entirely, as its nutrition is poor.
The stapes is the most resistant of all, especially in its foot-plate, as it is nour ished by the vascularity of the inner wall of the tympanic cavity, of which it is practically a part. The head and aura of the stapes may be destroyed by necro sis in some virulent cases. But, as a rule, it persists the longest of the three bonelets, thongh it may remain invisible through the perforated membrana, be cause buried in the swollen mucous mem brane of the drum-cavity. As this swell
ing goes down under treatment and the discharge ceases, the stapes comes into view, if still intact. The subjective symptoms of chronic purulent otitis media are hardness of hearing, deafness; tinnitus of more or less intensity, either constant or interrupted; ear-vertigo at times in adults, and in children attacks of so-called "gatherings in the ear," and earache with, of course, impaired hear ing and, sometimes, tinnitus. Adults, too, will have attacks of earache if they allow cold water or cold air to enter the diseased ear, or if they neglect a cold in the head.
Effect of atmospheric changes on the hearing in chronic catarrhal otitis media: The bearing in at least 70 per cent. of eases with chronic catarrhal deafness be comes n-orse under adverse weather con ditions. The danger of impairment of hearing, as influenced by atmospheric changes, is determined to a great extent by the location and character of the pathological process in the tympanic cavity. The morbid alterations most sus ceptible to barometric variations are those of hyperplasia. In purely atrophic changes in the middle ear weather varia tions have little or no elTeet upon the auditory: function. Atmospheric influ ences also impair the hearing by unfavor ably affecting catarrhal processes of the upper respiratory tract and Eustachian tube. All things being equal, the im paired hearing in chronic catarrhal otitis is diminished more (under favorable weather influences) in those whose gen eral health is below par than in those otherwise healthy. Seymour Oppen heimer (N. Y. Med. Jour., Oct. 21, '99).
Treatment.—The first endeavor should be to render the external auditory canal and middle ear aseptic. Of course, ton must never be worn in the chronic ally-running ear. If the discharge is too thick and too copious to mop out, it may be syringed out of the ear by means of warm water previously boiled. To this may be added a little salt, carbolic (1 to 40), or equal parts of alcohol. Once or twice in twenty-four hours is often enough in the worst cases. If the dis charge is not copious it may be removed with an absorbent-cotton mop, previously singed, and then 10 drops of an anti septic solution may be put into the ear. A solution of formalin (1 to 1000 or 500) or a solution of carbolic acid (1 to 90) may be dropped in, and allowed to lie there a few minutes, and then turned out on a towel. Where there is a tend no- to granulations absolute alcohol 1,,av be used instead of the above. This trtatment mav be repeated once or twice a day in the worst cases, then once a day and finally every second or third day, as tIe distliarge lessens. This or a similar rvative antiseptic treatment, per d in for many months, will usually hssvii the discharge and in many cases ltcek it. especially if the perforation of ;lie membrane is below the folds and the Iskase largely or entirely in the lower Fart of the drum-cavity, or atrium. If 'he sole perforation is in the membrana flaceida. and the purulency chiefly or entirely in the attic, or recessus epitym i anicus. it cannot be cured, as a rule, by local antiseptics.