Practitioner's handbook of diseases of the ear and naso-pharynx / by H. Macnaughton-Jones.

  • Macnaughton-Jones, Henry, 1844-1918.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Practitioner's handbook of diseases of the ear and naso-pharynx / by H. Macnaughton-Jones. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    22/204 (page 6)
    deafness in these patients, I find as follows :— Table IV. Extenial Ear and Meatus. Cerumen (with epidermis and aspergillus in some instances), present in 295 Tumour of auricle ... ,, 5 Injury of auricle ... ,, 4 Congenital abnormalities of auricle ,, 4 Absence of meatus . . ,, 1 Foreign bodies . . . 18 Inflammatory states of the meatus ,, 179 Furuncle and abscess . . ,, 88 Exostosis .... „ 5 Eczema..... ,, 46 Middle Ear and Eustachian Tube. Myringitis .... present in 31 Catarrhal states of the tym- panic cavity . . . ,, 202 Collapse, closure, and obstruc- tion of the Eustachian tube from various causes . . ,, 159 Unclassified aftections of the middle ear. . . . ,, 105 Membranatympani perforated in ,, 218 Polypus of external or middle ear ,, 61 Mastoid process ... ,, 7 Internal Ear and Lahyrhith. Affections of (registered). . . .71 There are some broad conclusions which may be drawn from these tables. (1) That a very large proportion of the aural aftections for which -n-e are consulted, both those of an inflammatory character and those in which there is deterioration of function, is due to essentially preventible causes, or causes over which the conti'olling influences within the reach of every physician and surgeon can be exerted so as either to prevent or minimise their pernicious eff'ects. (2) That the external ear furnishes a large proportion of the diseases we are called on to treat, and that (to take a low estimate) in some 40 per cent, of such patients cerumen (and its associated and attendant evils) is the primary cause of the trouble, and produces the symptoms for which we are consulted; and that of the remaining affections of the external ear, inflammation of the meatus, in various degrees and stages, is the condition we have most frequently to combat and limit. (3) That chronic, dry, or moist catar- rhal states of the middle ear furnish the next largest mimber of patients, associated with which we frequently find closed, obstructed, or collapsed Eustachian tubes. Of the 2000 patients tabulated, more than one-third distinctly camfe under this | head, and in over one-third of these closure or obstruction of the Eustachian passage was registered. But this, as I have already shown, is to be regarded as only approximately accurate, as in the classification of a large proportion of these cases the secondary condition has not been included. This applies more particularly to the hospital register. I should say that at least two-thirds of these middle-ear cases were compli- cated with, or owed their intra-tympanic mischief to. Eustachian collapse or closure. We may also, I think, draw this general conclusion, which has an important bear- ing on aural therapeutics, viz., that the practitioner in daily practice has princi- pally to deal with two causes of in- flammatory aftections of the ear and deafness,—in the external ear accumula- tion of cerumen and its accompaniments, epithelium and fungus; in the middle ear tubal collapse and closure and obstruc- tion. Side by side with this inference I would notice the number of cases of perforation, both acute and chronic, of the drum-head. Perforation was pre- sent in 132 ears out of the 500 private patients; and 218 of the 1500 hospital cases had an opening in the membrane of one or both ears. This would represent over 17 per cent, of the entire number of patients as having had a perforation of the membrane in one or both ears. Analysing a report of 1000 cases of ear disease treated in the Glasgow Western Infirmary, published by Dr Barr, we find that the auricle and auditory canal were aft'ected in 14 per cent., the middle ear (tympanum. Eustachian tube, and mastoid cells) in 81|^ per cent., and the internal ear in 4| per cent. Of the 1000 cases, the same disease existed in both the ears in 516 persons, and a different diseased state in each ear in 88 persons. The very small proportion of internal ear aft'ections Dr. BaiT accounts for by the exclusion of all cases save those in which the nervous apparatus was primarily aft'ected. But he is careful to remark that the cases in which the inner ear becomes gradually involved are generally the result of the extension to the structures of the labyrinth of disease which has begun in the middle ear. It is worthy of notice that of these 1000 patients only two suffered from exostosis of the meatus, in one of these both ears