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Inflammation of the Drum of the Ear.
Symptoms.-The symptoms indicating the beginning of the affection vary somewhat with the cause of the inflammation. In those cases in which the affection follows scarlet fever and measles, the symptoms which mark the beginning of it may be less severe and pronounced than is otherwise the case.
In many cases inflammation of the drum of the ear begins without apparent cause. In some it results apparently from exposure to cold. It is especially frequent after a cold wind has been allowed to blow directly upon the ear, or after the individual has been sitting in a draught.
The first manifestation is a slight sense of deafness and uneasiness in the ear. This is often followed by a decided chill, after which the patient becomes quite feverish. Headache, a thick coating on the tongue, etc., the usual accompaniments of fever, may be present. Meanwhile the pain in the ear becomes more and more severe, until it is finally excruciating. If the patient be a child, he cries constantly, complains of the ear, cannot eat or sleep. If it occur in an adult, the individual is compelled to give up his occupation entirely, and soon shows by his pallor and by the pinched expression of his face that his suffering is extreme. The affected ear is for the time being perfectly deaf.
This condition lasts until the head of the drum gives way from the pressure of the matter confined behind it. This is a moment of supreme relief to the patient. The pain which has rendered his life a torment for several days suddenly subsides. In most cases the patient drops into a refreshing slumber within a short time after the pain has been thus relieved.
The matter which gushes from the ear at the time of the bursting of the membrane is extremely thick and yellowish. After a day or two it may become somewhat thinner and less profuse, but it is apt to persist for weeks. Indeed, if neglected and allowed to go without treatment, this running from the ear may annoy the patient for years. In fact, many individuals become so accustomed to it that they cease to think about it at all. It is not uncommon to find persons who have had a running from the ear since childhood, and who have never sought advice or treatment.
It is one of the curious popular fancies that a discharge from the ear, which has already lasted for some time, is supposed to be quite necessary to the person's health. Any suggestion by the physician to the effect that measures should betaken to stop a discharge from the ear in a child is often met by the alarmed remonstrance of the parents, who fear all sorts of imaginary evil from what they term " driving in " the discharge.
It must be stated most emphatically that such a notion is quite erroneous and without foundation of any sort. It is indeed highly desirable that a discharge from the ear should be stopped as early as possible; for, if no measures are taken to relieve the condition which causes this discharge, loss of hearing in the affected ear is certain to occur. If, therefore, there be any chance of saving the hearing, it will be necessary to adopt the most energetic measures at the earliest possible moment for stopping the discharge. It might be mentioned as an additional inducement to cure this difficulty, that a long-continued discharge is sure to cause rawness and soreness of the skin in the auditory meatus, as well as on the adjacent parts of the face and neck.
Treatment*-Whenever the symptoms above described occur in an adult, an inflammation of the drum of the ear is probably present. In children it is sometimes difficult for a nonprofessional person to detect the existence of this affection until the matter breaks out of the ear, for there are no signs on the outside of the head or ear by which the formation of matter in the drum of the ear can be detected. Moreover, the symptoms are sometimes so severe as to direct attention to the brain rather than to the ear, for convulsions and delirium may occur. In general it may be said that if the pain be of a throbbing character, the affection is probably in the middle ear.
At times, this inflammation causes the death of the patient by spreading to the membranes which cover the brain, for there is only a very thin shell of bone between the cavity of the middle ear and the cavity in which the brain rests.
Treatment.-An inflammation in the drum of the ear should be treated promptly and energetically. In former days it was the custom to apply three or four leeches around the external ear, especially over the bony prominence just behind the ear. lit these latter days leeches are not so fashionable ; but surgeons frequently scarify this part of the skin - that is, make a number of fine cuts so as to permit a flow of blood. This should not, however, be undertaken by any one except the surgeon.
The remedies which maybe adopted in the household are, first, hot fomentations to the ear and its immediate vicinity. Cloths should be saturated with water as hot as the patient can bear and applied to the ear ; these should be covered with oiled silk or rubber sheeting, so as to keep the cloth warm, and the fomentation should be changed frequently-even every half hour if necessary - in order to keep the parts constantly moist and warm.
The comfort of the patient will be further promoted by frequent injections of hot water into the ear. These will be best made by the use of a fountain syringe. Numerous forms of fountain syringes - most of them made of rubber-are to be found in the market. If none of these can be procured, a fountain syringe can be extemporized by hanging a small vessel containing the hot water two or three feet above the patient's head ; a rubber tube is then arranged as a syphon so as to conduct the water to the orifice of the ear. A stream of hot water may be allowed to flow gently into the ear for fifteen minutes at a time. This injection may be repeated every hour, or even less. After the injection the following mixture may be employed :
Laudanum, - One ounce.
Glycerine, ----- One ounce.
Water, ------ Two ounces.
A teaspoonful or two of this may be poured into the ear, after which a small plug of cotton is applied so as to retain the liquid.
If the patient be feverish, a hot bath will be beneficial. In any case, care should be taken to secure free evacuation of the bowels, for which purpose a teaspoonful of the citrate of magnesia may be taken.
It frequently becomes necessary to administer opium iāi order to quiet the pain. If the patient be a child over five years of age, a teaspoonful of paregoric may be given. This should be repeated in one or two hours if the pain is still severe. In this case, as in every other, it must not be forgotten that children are especially susceptible to the action of opium in any form, and that great care must be observed in administering it to them. If these measures do not give relief, the following ointment may be applied to the skin over the bony prominence just behind the ear :
Veratria, ----- Fifteen grains.
Vaseline, ----- One ounce.
It is sometimes possible to check the inflammation by these means, so that the affection subsides without causing the membrane of the drum of the ear to give way; but in the majority of cases the inflammation results in the production of so much matter that this membrane becomes softened and gives way.
After this has happened, injections of warm water into the ear should be made five or six times a day, or even oftener if necessary to keep the parts clean. After the first two or three days, we may employ to advantage the following injection, which will tend to diminish the production of matter, as well as to increase the comfort of the patient:
Listerine, ------ One ounce.
Glycerine, ------ Two ounces.
Water, ------ Three ounces.
After the ear has been washed out with hot water, a tablespoonful of this may be injected slowly into the cavity. This injection may be repeated three or four times a day.
Treatment of "Running from the Ear."-After the ear has discharged for many months or years, it is often a troublesome and difficult undertaking to arrest the formation of matter completely. In many cases there is a growth of " proud flesh " in the ear, which keeps up a constant discharge. If this be the case, the matter must be referred to a competent surgeon, since the removal of this proud flesh is an undertaking requiring skill and care. In many other cases, however, it is possible to stop the discharge by simple injections into the ear. It will be, therefore, advisable to try the effect of these simple measures first. The first item of treatment is perfect cleanliness. The ear must be syringed out as often as is necessary to keep the parts clean. This may be done with simple warm water.
Four or five times a day there may be used the following injection :
Listerine, - One ounce.
Tannic acid, ----- Three drachms.
Water, - Five ounces.
An ounce of this may be used for an injection ; the solution should be thrown into the ear very gently and as much liquid as possible allowed to remain in the cavity of the ear. After this has been done, a piece of cotton smeared with vaseline maybe inserted into the cavity of the external meatus.
In many cases the skin around the opening of the ear becomes raw and sore ; if the ear be kept perfectly clean, this soreness will probably disappear spontaneously. In any case the healing of the skin may be hastened by applying the following ointment :
Diachylon ointment, - One ounce.
Vaseline, ------ One ounce.
This treatment should be faithfully pursued for a month or six weeks, even though the discharge may cease somewhat earlier than this. If these measures fail, it will probably be necessary to call in the services of a surgeon.
The effects of an inflammation of the ear resulting in the discharge of matter vary in different cases. Sometimes the discharge ceases, under appropriate treatment, in a few weeks, and the individual retains a very fair degree of hearing. Yet in these cases, as well as in others less favorable, the opening in the membrane of the drum of the ear persists ; it is, indeed, rare that this opening heals spontaneously, or can even be made to heal under treatment.
This fact is mentioned because the idea prevails that if the u drum of the ear "-that is the membrcCne of the drum of the ear - be broken, the hearing is irreparably lost. This is an erroneous idea, since many patients who have suffered in this way hear quite acutely. The loss of hearing seems to depend rather upon the damage that has been done within the cavity of the middle ear than upon the size of the opening in the membrane.
Various operations have been devised for closing the opening in the membrane of the drum ; these have been in some instances successful. In other cases attempts have been made to substitute artificial membranes to replace the natural one where this has been destroyed. In some instances a fair degree of success has been obtained, and the hearing of patients has been decidedly improved, but such cases form a small minority.
In the majority of instances in which the hearing has been lost in consequence of an inflammation resulting in a running from the ear, there is no hope of improvement. The running can be stopped, but the damage to the hearing apparatus is beyond repair.
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