More accurate information is gained from the use of the catheter than from Politzer's inflation, and it is the safer method to employ when a cicatrix or atrophied patch exists in the tympanic membrane, as by the latter method rupture of these areas might occur. Further, the catheter has the advantage of only inflating one ear, and thus preventing any undue strain being put upon the other. In children the catheter can seldom be employed, on account of the difficulty in passing it.
Considerable information may be derived from inflation. If the Eustachian tube is patent, a full clear sound is heard close to the examiner's ear through the auscultating tube. If the Eustachian tube is obstructed, the sound is fainter and more distant. If there is fluid in the tympanum, a fine moist sound may be detected, which must not be confounded with the coarser and more distant gurgling sound associated with moisture at the pharyngeal opening of the tube. If a small dry perforation exists in the tympanic membrane, the air may be heard whistling through it, while if the perforation is large, a sensation which is almost painful may be produced in the examiner's ear. If there is fluid associated with the perforation, these sounds may be accompanied by a bubbling noise. The effect of inflation upon the hearing must be carefully tested and recorded.
Affections of the External Ear
Deformities.—The auricle, together with the external auditory meatus, may be congenitally absent on one or on both sides. The condition is not amenable to surgical treatment. Double auricles are occasionally met with; more frequently rudimentary auricular appendages about the size of a pea, consisting of skin, subcutaneous connective tissue and nodules of cartilage occur in front of the tragus, on the lobule or in the neck. These appendages should be snipped off with scissors. These congenital deformities are due to errors in development of the mandibular arch, and are frequently associated with macrostoma, facial clefts, and other malformations of the face.
Outstanding ears may be treated by excising a triangular or elliptical portion of skin and cartilage from the posterior surface of the pinna and uniting the cut edges with sutures. Abnormally large ears may be diminished in size by the removal of a V-shaped portion from the upper part of the auricle.
The term hæmatoma auris is applied to a sub-perichondrial effusion of blood, which may occur either as the result of injury to the auricle, for example in football players, or as a result of trophic changes in the cartilage and perichondrium. The latter form is not uncommon among the insane. A more or less tense fluctuating swelling forms on the anterior surface of the auricle, presenting in some cases a distinctly bluish coloration. Inflammation may ensue, and in some cases suppuration and even necrosis of cartilage may follow.
The treatment in a recent case consists in applying cold or elastic compression with cotton-wool and a bandage, or in withdrawing the effused blood by means of a hollow needle. In the event of suppuration supervening, incision and drainage must be carried out.
Epithelioma may attack the auricle and extend along the external auditory meatus. It begins as a small abrasion which refuses to heal, and is attended with a constant fœtid discharge and intense pain. The disease may spread to the middle ear and invade the temporal bone, and facial paralysis then ensues. The adjacent lymph glands are early infected. The treatment consists in removing the growth freely, and excising the associated lymph glands at an early stage of the disease. In inoperable cases radium or the X-rays may be employed.
Rodent cancer also may attack the outer ear.
Impaction of Wax or Cerumen.—Hyper-secretion may result from unknown causes, or it may accompany or be induced by the discharge from a chronic middle-ear suppuration. The association of these two conditions should be borne in mind. An accumulation of wax may be caused by the too zealous attempts of the patient to keep the ear clean, the wax being forced into the narrow deeper part of the meatus.