This is a very serious affection of the ear, and one to which about one-half of all cases of deafness are due. The disease is generally accompanied by slight pain, heat, and uneasiness about the ear. It is often the result of repeated attacks of acute catarrh of the middle ear. In a majority of cases it results from long-continued nasal and pharyngeal catarrh. Patients frequently complain of sounds in the ear, like the crackling of air bubbles. There is generally more or less ringing in the ears and a sense of fullness. Dizziness is also a not infrequent symptom. In many cases there is a tendency to an accumulation and hardening of the ear-wax. Generally, also, a slight tenderness will be found by pressing with the finger in the hollow just below the ear, or over the front part of the ear. In some persons, however, scarcely any symptoms except those of impaired hearing are present. In not a few instances the disease progresses so insidiously that the patient is unaware of his condition until his hearing is destroyed. On the day of this present writing, we have met with two illustrations of this fact. A clergyman called at our private office, and with much concern apprised us of the fact that he had just made the discovery that the hearing of his right ear was very greatly impaired. His attention was called to the fact by incidentally placing a watch to his ear to see if it was running. On testing the ear, we found that it possessed only one sixteenth of its natural acuteness, and upon examination of the left ear, we found, very much to the gentleman's surprise, that its hearing was also very greatly impaired, the watch which should have been heard at a distance of four feet being barely made out at a distance of a foot. Within an hour, while examining a patient from a distant State with reference to the condition of his general health, we incidentally tested his hearing, although he remarked very emphatically that his ears were perfectly sound. In this case, we found the left ear had lost fully three-fourths of its acuteness, while the hearing of the right ear was almost entirely destroyed. The gentleman was so greatly astonished at the result of the examination that he was only convinced of his real condition after the test had been repeated several times.

A curious phenomenon is sometimes observed by persons suffering with chronic catarrh of the ear. When surrounded with loud noises, as riding in a railroad car, they are able to hear as well as, or even better than, persons whose ears are perfectly healthy, although very deaf at other times. The cause of this improvement of hearing is not well understood, but it has been thought that it may be due to the fact that the powerful vibrations produced by loud noises set in motion the membrane of the ear, which is thickened and rendered rigid by disease. An English physician, taking a hint from this fact, has suggested the exposure of the ear to loud noises as a mode of treatment. This plan of treatment has been termed ear gymnastics.

In order to ascertain whether the Eustachian canal is open and the membrane moveable, it is necessary to inflate the ear. This is done by forcing air into it by means of Valsalva's method, which consists in attempting to blow the nose while the nostrils are tightly closed with the thumb and finger, or still better, by Politzer's method, in which air is forced into one nostril by means of a rubber bag, Fig. 455, the patient swallowing at the same moment that the air is forced into one nostril, the other being closed.

Fig. 455. Politzer's Rubber Bag for Blowing Air into the Nostril.

Fig. 455. Politzer's Rubber Bag for Blowing Air into the Nostril.

In cases in which the air cannot be made to enter the ear by either of these methods, it is necessary to use the Eustachian catheter. Fig. 456. When air enters the ear, the movement of the structures of the middle ear can be distinctly heard by means of the otoscope, or diagnostic tube, Fig. 457, one end of which is placed in the ear of the examiner, and the other in the ear of the patient undergoing examination. These instruments are also very essential in the treatment of many diseases of the ear.

Fig. 456. Eustachian Catheter.

Fig. 456. Eustachian Catheter.

Fig. 457. Otoscope or Diagnostic Tube.

Fig. 457. Otoscope or Diagnostic Tube.