EXTERNAL EAR, DISEASES OF THE.—The external ear furnishes about one-fourth of all aural work, by reason of its diseases and anomalies; and, in consideration of the fact that much of our examination and treatment of the middle ear has to be through this chan nel, its careful study is requisite in otology. Statistical tables show that more than half of these are cases of im pacted cerumen, and the bulk of the re mainder fall under the convenient—if vague—headings of diffuse, or eczem atous, and circumscribed, or furuncular, inflammations; but the rare affections have still enough of pathological in terest to call for brief discussion.
Malformations.—Many of the malfor mations of the auricle have only embry ological interest; but the rudimentary microtia is usually accompanied by steno sis or absence of the auditory canal, and the question of operative intervention comes up,—generally for a negative an swer. Possibly a crumpled auricle can be straightened out by plastic operation, for more natural growth and a covered bony canal can be opened; yet too often exploration fails to find the canal, and even the tympanum may be undeveloped; so any opening of the bone is counter indicated. Otherwise any reasonable plastic surgery may be attempted. The little congenital fistula seen at times above the tragus may suppurate and de mand curetting or excision; and auricular appendages or reduplications of the auricle may call for removal.
Injuries.—Wounds, burns, and ab scesses (see FIIRUNCLE, below) should receive the usual surgical treatment, the last being rare except in the lobule, where generally due to septic piercing for ear-rings.
Piercing the lobule for ear-rings often leads to secondary infections. Lupus, tubercle, and syphilis are among the maladies thus communicated. Fournier (Jour. des Mal. Cut. et Syph., vi, p. 321, '94).
Fracture of the external osseous canal and its integumentary tissues by force transmitted through the inferior maxilla is not infrequent, and its importance arises from the fact that it may be over looked entirely, or else mistaken for a fracture of the base of the skull or for a ruptured membrana tympani. Barclay
(Med. Review, May 12, '94).
Case of infection of the external car from vaccine inoculation. The poison was conveyed from the arm of an in fant by the nurse to her own auditory meatus. Recovery ensued in three weeks, leaving a characteristic scar in the lower wall of the auditory canal. Szenes (Germ. Otol. Soe.; Arch. f. Ohrenh., Sept., '95).
Purulent otitis, erysipelas, adenitis, impetigo, syphilis, lupus, and simple sup puration which by extension may be come severe and even threatening in its consequences, may all result from the piercing of children's ears without proper antiseptic precautions. Rocha (Jour. de Clin. et Thor. Inf., Feb. 6, '96).
Case of gangrene of the ear in which the necrotic process involved both an terior and posterior surfaces of the concha. S. S. Bishop (Jour. Amer. Med. Assoc., Mar. 2S, '96).
In the majority of cases it is impos Bible to diagnosticate fracture of the auricle by simple visual examination; but manipulation with both hands—one grasping the pinna and the other the lobule—will elicit crepitus, and if trans illumination is used the line of fracture can be readily made out, especially• in flammatory changes have not progressed to any great extent. Lewis S. Somers (N. Y. Med. Jour., Jan. 22, TS).
Thematoma and perichondritis are often of traumatic origin, each marked by effusion between the perichondrium and cartilage with serious impairment of its vitality. Deformity is apt to follow; but early relief of tension and judicious use of massage are our best measures for cure of mitigation. Any inflammatory symptoms, such as usually differentiate these otherwise similar affections, are to be allayed before much stimulation is attempted.
Interesting case of lixmatoma of the ear seen in which the staphylococcus pyogenes aureus was found. J. Justin McCarthy (Maryland Med. Jour., vol. xxxvii, No. 3).