Earache: Causes, Treatment, Relation of the Exanthemata Thereto
GEO. L. RICHARDS
Boston Medical and Surgical Journal
some cases presented indications of being lined hy thin endothelial cells. In other eases, tins e.iidothellal lining could not be made out. At the margin of a very few of the spaces a few liai tened multinucleated, atypical cells were ohscrved, which were regarded as of the same character as those seen in Case I. No evidence of a bacterial origin for the condition was obtained. As in the first case the spaces seemed to arise from the dilatation of lymph channels. It will be seen that both cases
... followed abdominal hysterectomy, aud the thought immediately suggests itself, may not this couditiou in some way be due to a blocking of the lymphatic system as a result of the operation? As to the formation of gas in these dilated lymph vessels, no further explanation can as yet be offered. -•-Who of us has not been called, many times it may be, to relieve, for child or adult, that most excruciating pain, an acute earache ? Who of us has not felt himself or herself almost helpless in its presence, and wondered what he or she could do to relieve the pain, while tho little sufferer moaned and tossed and cried, and seemed not a whit the better for all we were doing? Have wc not seen the pain last for hours until finally, when child and attendants were well-nigh exhausted, nature has perforated the drum, the pain has ceased and the child lias gone to sleep ? Following this we have seen the ear discharge pus for a longer or Bhorter time, and the pain having ceased, the case has passed from our observation. Such being the facts, aud the unsatisfactory nature of the treatment being generally recognized, I offer no apology for bringing to your notice to-night the subject of earache considered broadly as to its causes, aud with especial reference to treatment and the relation of the exanthemata thereto. I include under the term earache those acute affections of the external canal, the drum and the tympanic cavity characterized by acute, more or less severe, pain in the ear. (1) Otitis media externa, including furuncle therewith. This affection is characterized by swelling and pain in the external canal, radiating to and sometimes involving the drum membrane. Tho pain varies with the severity and extent of the inflammation, but is not as severe as in affections of the deeper parts. In furuncle the mouths of one or more glands become stopped up j there is localized swelling and great discomfort, sometimes great pain, though in the main it is discomfort rather than severe pain. In my experience this is more common among adults than iu children. In the more diffuse form there is general swelling, and the whole canal may be closed. I will not consider the etiology but confine myself to the question, Given the condition, what can we do for its relief? If the inflammation has gone on to pus formation, we should incise and liberate the pus, remembering that the 1 Read before the New Bedford Medical Society, March 28, 1898. amount of. pus is always .small, and that relief often comes from the incision even when no pus is present. Before the inflammation has reached the pus stage two methods of treatment are applicable, both of which have been found very useful : gelatin bougies as originally introduced by Gruber, and local applications. A modified formula for tho bougies is given farther on. The bougie is inserted into the swollen external canal, and is allowed to dissolve there ; and good results follow. For this affection I am iu the habit, however, of usiug a simpler remedy which has the merit of being always easily obtained and of invariably giving relief, never doing any harm, and of being applicable at any stage of the inflammation. I refer to a (ive-per-ceut. solution of carbolic acid in pure glycerin. The carbolic acid produces anesthesia and eases the pain, while the glycerin, on account of its ailinity for water, rapidly removes the serum from the part, and the swelling, heat aud tension subside. As the heat and tension are often the things most complained of, the relief afforded is very great. The carbol-glycerin is applied on a small wad of cotton so rolled as to go as deeply into the canal as possible, and changed every two to four hours. Once the patient has been shown how he can do this by the doctor, he will readily make the changes himself. Suppose this does not wholly relieve, aud it becomes necessary to incise the furuncle or any part of the swollen canal ? Do not attempt to do it without an anesthetic unless you have a specially tractable patient, or tho result will be unsatisfactory to both. The region is so tender that it is practically impossible for any one to hold still. Give a little chloroform or ether to primary anesthesia, and then with a suitable knife make an incision long enough and deep enough to go through all the tissue it is desired to open. The bleeding will doubtleBS be profuse, but will relieve rather than otherwise. Do not be disappointed if no pus comes; with an openiug deep euough, the pus, if there is any in the vicinity, will find its way out. Apply the carbolic-acid-glycerin compound as before, aud soon the patient is well. (2) Earache due to acute trouble in the middle ear from whatever cause. This is most common in children, less bo in adults. In the majority of instances it is due to extension of inflammation from the nose and naso-pharynx along the Eustachian tube to the middle ear. Hence the cutarrhal troubles of childhood, enlarged tonsils, adenoids and the exanthemata are the most common causes. The intimate relationship between adenoid growths and ear trouble has been often pointed out. Seventy-four per cent, of Meyer's cases of adenoid growth had ear trouble ; and it is the experience of every one paying any special attention to the matter that a very large proportion of the cases of running ears have these growths as a cause, or one of the causes. The close anatomical relationship between the adenoid growth and the mouth of the Eustachian tube is sufficient to account for this. Furthermore the adenoid, being a lymphoid structure, is much more swollen and prominent at some times thau at others ; hence it may complicate the case many times when it is not the prime cauBe.