The healthy ear needs no artificial cleansing of its canal. Nature has pro vided that the epithelium of the centre of the drum-head shall grow faster than at any other point; hence it tends to over grow its surroundings, as it were, and, pushing the older cells before it, to creep along the canal-wall. Superficial extravasations on. the drum-head can thus be seen to migrate off its surface and a little way along the canal, before they are thrown off; and this outward growth carries all foreign material away from the tympanic membrane, where it might seriously impede function. Out side of the narrowed "isthmus" of the canal the wax-glands are present, and one of the functions of the wax is doubt less to agglutinate the flaky material. The motions imparted by the jaw to the lining of the canal is then probably all that is needful to convey these particles to the exit,—the spring of the hairs upon which they get caught serving to throw them at times out upon the shoulder.
Excess of wax in the external meatus may be caused by (a) frequent hyper aemia of this region; (is) contraction of the meatus; (0 improper cleaning of the external meatus by inserting the twisted corner of a wash-rag or towel or similar contrivance into the ear. Parents and nurses should be especially warned against mechanically irritating the lining of the canal by undue cleanli ness, and it should be pointed out to them that if the concha be wiped out with a soft, moist rag the canal will take care of itself, and that anything intro duced into the meatus is likely to do harm and result in anything but the de sired cleanliness. Stout (Proceedings Phila. County Med. Soc., Mar., 1000).
When, through defect of this natural cleansing process or artificial interfer ence with it, collections form within the canal, they are commonly at the middle third and may fill almost completely this tube; but so long as the smallest crevice remains through which the sound-waves can reach the tympanum there may be no symptom of their presence. Pressure may be noted or other irritation lead to interference, and then the mass may be pushed down upon the drum or made to occlude the meatus. More often the entrance of moisture swells the hydro scopic mass; and sudden and complete closure of the ear, with deafness, tinni tus, and autophony may alarm as well as distress the patient. Sudden deafness without pain or vertigo is apt to signify impacted cerumen.
History of a patient is given in whom tinnitus was so intense and took such definite shape (threatening.. or deviliAl voices, etc.) as to induce great mental depression—not, however, giving rise to systematized delusions. Twelve hours after the removal of masses of inspis sated cerumen and pieces of tobacco from the ear, the "voices" disappeared entirely and were not noticed again. This case illustrates how certain abnor mal mental states may be induced by the mere presence of foreign bodies in the auditory canal. Editorial (\lass. Med. Jour., July, '91).
Occurrence of ear-cough, deafness, ver tigo, and nausea from the presence of hard cerumen in the ear. In nervous persons a melancholic form of dys thymia may be produced by mechanical irritation in the external ear. E. W. Merric (Brit. Med. Jour., Oct. 10, '96).
The opposite ear is commonly in sim ilar condition; so the habit of examining it first may save us from letting the same experience befall the patient there. A dark-brown or blackish, greasy mass can usually be seen at the first glance, even on drawing the canal straight and letting the light from a window fall into it past the examiner's head. Sometimes the hairs are enough to hide it and must be pressed aside with a speculum. This must here, as always, be used only under good illumination of the canal or it may serve to press the mass all the more dis tressingly. In all these examinations, as also in all manipulations in the canal, the normal configuration of the meatus must be borne in mind. It has an oval lumen with the longer diameter vertical at the exit but inclining forward as we go in. Its axis is spirally curved and tends usually upward and forward as we pass in, but the floor seems to sink a little as we approach the drum-head, consti tuting a slightly broadened, deepened miens, out of which foreign materials are rather hard to remove. The soft parts constituting the outermost third of the canal exaggerate the curves and have to be drawn up (down, in the infant) and back and out in order to straighten it as much as possible, both for seeing in and for washing out anything there retained. The helix should therefore always be grasped between the index and middle fingers, so that this traction may be efficiently made, and yet the thumb and index-tip be left free to manipulate a speculum or otherwise serve us.
Wax plugs and all other foreign bodies should be washed out with the syringe. Only where this has been fully and skill fully used without avail has the most expert a right to employ other instru ments; and then only with a gentle, steady hand and on a quiet or etherized patient. In almost all cases the syringe is the most efficient as well as the safest and gentlest means at our command; but it must be better used than commonly, if it is to justify this claim. A small, smoothly-working piston-syringe is to be preferred, with a small tip that can enter a little way into the canal without ob structing the view. The fluid employed should be hot water. It matters little or not at all whether this is medicated; soda, boric acid, or any harmless drug may be dissolved in it if the surgeon be lieves it better than pure water. The best solvent is really heat; and a tem perature of 110Q-115° F. is generally well borne and less apt to cause dizziness than "luke-warm" water. A cup of some sort should be held beneath the lobule and the shoulder covered with a towel; then with the canal well illuminated by the forehead-mirror or other means and drawn straight as above described, we gently begin to inject the hot water. Perhaps along the upper back wall is the best direction for the stream; but this must be varied as sight of the mass sug gests. Beginning gently, the first few drachms serve to moisten the parts, the next to disintegrate the plug, discoloring the returning fluid with the dissolved I wax; usually with my two-drachm instru ment the eighth syringeful washes the mass out into the cup, with an expendi ture of 2 ounces of water and five min utes, at most, of time.