2. Diseases of the Internal Ear affect that part of the organ which is situated internal to the drum-membrane. The most common of these is inflammation of the middle car, which may occur as a catarrh with mucous accumulations in the tympanic cavity, or as a suppuration with a purulent condition of the inflam matory exudations. These forms differ from each other largely in the degree of intensity, taking into consideration also the factor of in fection.
Acute Catarrh of the Middla Ear usually begins with sudden, piercing pain in the ear, with ringing and beating, and with a sensation of obstruction. If the function of hearing is not impaired, only an inflammation of the tympanic mem brane (the drumhead) may be present ; if the acuteness of hearing dimin ishes, the middle ear is usually involved also. A rise of temperature is often present, and may he very marked in children, leading to spasms, and frequently disturbing the general health to such an extent that confusion with other affections may occur. All the disturbances increase in intensity during the night ; and the act of chewing is often a very painful process.
If perforation of the drumhead takes place, the pains usually cease, but not the fever. A sense of fullness and pressure, difficulty of hearing, and ringing of the ears may persist. Sometimes perforation occurs during the first twenty-four hours of the disease, causing a flow of bloody mucus ; at other times it may take several days, and incision into the drumhead must often be resorted to in order to relieve the patient of his pain. In cases of simple catarrh of the middle car, the drumhead usually heals in a few days, provided infection does not take place.
Injections of oil into the ear, so widely used, tend to introduce bacteria into the organ, thus adding the factor of infection. Patients should be confined to bed, and small cotton pledgets soaked with antiseptic solutions should be used to cleanse the external car, while great care should also be taken to keep the month and nose as clean as possible. Hot-water bottles are often very grateful to the patient, as they diminish the pain of au earache. Breathing hot smoke into the car is sometimes of service, but if the little patients are unable to sleep by reason of the pain, the inflammation is usually acute enough to demand operative treatment of the car-drum.
Purulent Inflammation of the Middle Ear (" running of the ear ") begins as a simple catarrhal process, but the disease is more acute and the symptoms more marked. Beating sounds like the strokes of a hammer occur, and
the entire side of the head becomes painful. Chewing is often very difficult, and even the concussion caused by walking intensifies the pains, which are scarcely endurable, especially at night. The general symptoms in children are sometimes so severe as to resemble a meningeal inflammation Violent chills arc frequent. Perforation of the drumhead takes place under turbulent manifestations, and the purulent discharge is often so profuse that the pillow or bandage may be soaked by it. In cases of severe suppura tion it may happen that large portions of the drumhead, and even the ossicles are lost. Such severe cases are met with at times in measles and scarlatina, and may result in complete deafness. Sometimes the external auditory canal becomes inflamed also, or the affection may spread to the mastoid process. See MASTOID, DISEASES OE.
The disease may terminate in (I) recovery Nvithout permanent changes ; (2) in scars or permanent perforation of the drumhead ; (3) in loss of the ossicles of the middle ear or contracted scar formation of the middle ear with permanent difficulty of hearing ; (4) in transition into chronic suppuration ; or (5) in death from involvement of the brain. The occurrence of purulent suppuration of the middle ear may be favoured by frequent attacks of nasopharyngeal catarrh, and by enlargement of the tonsils, especially of the nasopharyngeal tonsil. The most serious cases of the affection are encountered as complications of scarlatina.
Examination and treatment by a specialist is imperative, and the belief that "running of the ears " is of little significance, or is even conducive to health, is thoroughly obsolete and pernicious. Running of the ear is a serious matter, and the advice of a layman is not reliable. The pain may be allayed by hot compresses, fomentations, linseed poultices, etc. Cold air and cool baths must be avoided. The extension of the process to the mastoid cells or to the meninges is accompanied by high fever, by headache, by soreness behind the ear, and by other localising signs. These cases need operation, and usually without delay. Chronic suppurative disease of the middle ear is not common. It requires operative treatment as a rule.