DISEASES OF THE 

EAR Modern scientific aural surgery and medicine (commonly known as Otology) dates from the time of Sir William Wilde of Dublin (1843), whose work marked a great advance in the application of anatomical, physiological and therapeutical knowledge to the study of this organ . Less noticeable contributions to the subject had not long before been made by Saunders (1827), Kramer (1833), Pilcher (1841) and Yearsley (1841) . The next important event in the history of otology was the publication of J . Toynbee's book in 186o containing his valuable anatomical and pathological observations . Von TrOltsch of Wurzburg, following on the lines of Wilde and Toynbee, produced two well-known works in 1861 and 1862, laying the foundation of the study in Germany . In that country and in Austria he was followed by Hermann Schwartze, Politzer, Gruber, Weber-Liel, Rudinger, Moos and numerous others . France produced Itard, de la Charriere, Meniere, Loewenberg and Bonnafont; and Belgium, Charles Delstanche, father and son . In Great Britain the work was carried on by James Hinton (1874), Peter Allen (1871), Patterson Cassells and Sir William Dalby . In America we may count among the early otologists Edward H . Clarke (1858), D . B . St John Roosa, H .

Knapp,

Clarence J . Blake, Albert H . Buck and Charles Burnett . Other workers all over the world are too numerous to mention . Various Diseases and Injuries.—Diseases of the ear may affect any of the three divisions, the external, middle or internal ear . The commoner affections of the auricle are eczema, various tumours (simple and malignant), and serous and sebaceous cysts . Haematoma auris (othaematoma), or effusion of blood into the auricle, is often due to injury, but may occur spontaneously, especially in insane persons . The chief diseases of the external auditory canal are as follows:—impacted cerumen (or wax), circumscribed (or furuncular) inflammation, diffuse inflammation, strictures due to inflammatory affections, bony growths, fungi (otomycosis), malignant disease, caries and necrosis, and foreign bodies . Diseases of the middle ear fall into two categories, suppurative and non-suppurative (i.e. with and without the formation of pus) . Suppurative inflammation of the middle ear is either acute or chronic, and is in either case accompanied by perforation of the drum head and discharge from the ear . The chief importance of these affections, in addition to the symptoms of pain, deafness, discharge, &c., is the serious complications which may ensue from their neglect, viz. aural polypi, caries and necrosis of the bone, affections of the mastoid process, including the mastoid antrum, paralysis of the facial nerve, and the still more serious intracranial and vascular infective diseases, such as abscess in the brain (cerebrum or cerebellum), meningitis, with subdural and extradural abscesses, septic thrombosis of the sigmoid and other venous sinuses, and pyaemia . It is owing to the possibility of these complications that life insurance companies usually, and rightly, inquire as to the presence of ear discharge before accepting a life .

Patterson Cassells of

Glasgow urged this special point as long ago as 1877 . Acute suppurative disease of the middle ear is often due to the exanthemata, scarlatina, measles and smallpox, and to bathing and diving . It may also be caused by influenza, diphtheria and pulmonary phthisis . Non-suppurative disease of the middle ear may be acute or chronic . In the acute form the inflammation is less violent than in the acute suppurative inflammation, and is rarely accompanied by perforation . Chronic non-suppurative inflammation may be divided into the moist form, in which the symptoms are improved by inflation of the tympanum through the Eustachian tube, and the dry form (including sclerosis), which is more in-tractable and in which this procedure has little or no beneficial effect . Diseases of the internal ear may be primary or secondary to an affection of the tympanum or to intracranial disease . Injuries to any part of the ear may occur, among the commoner being injuries to the auricle, rupture of the drum head (from explosions, blows on the ear or the introduction of sharp bodies into the ear canal), and injuries from fractured skull . Congenital malformations of the ear are most frequently met with in the auricle and external canal . Methods of Examination.—The methods of examining the ear are roughly threefold: (1) Testing the hearing with watch, voice and tuning-fork . The latter is especially used to distinguish between disease of the middle ear (conducting apparatus) and that of the internal ear (perceptive apparatus) . Our knowledge of the subject has been brought to its present state by the labours of many observers, notably Weber, Rinne, Schwabach, Lucae and Celle .

(2) Examination of the canal and drum-head with

speculum and reflector, introduced by Kramer, Wilde and von Troltsch . (3) Examination of the drum-cavity through the Eustachian tube by the various methods of inflation . Symptoms.—The chief symptoms of ear diseases are deafness, noises in the ear (tinnitus aurium), giddiness, pain and discharge . Deafness (or other disturbance of hearing) and noises may occur from disease in almost any part of the gar . Purulent discharge usually comes from the middle ear . Giddiness is more commonly associated With affections of the internal ear . Treatment.—Ear diseases are treated on ordinary surgical and medical lines, due regard being had to the anatomical and physiological peculiarities of this organ of sense, and especially to its close relationship, on the one hand to the nose and naso-pharynx, and on the other hand to the cranium and its contents . The chief advance in aural surgery in recent years has been in the surgery of the mastoid process and antrum . The pioneers of this work were H . Schwartze of Halle, and Stacke of Erfurt, who have been followed by a host of workers in all parts of the world . This development led to increased attention being paid to the intracranial complications of suppurative ear disease, in the treatment of which great strides have been made in the last few years . Effects of Diseases of the Nose on the Ear.—The influence of diseases of the nose and naso-pharynx on ear diseases was brought out by Loewenberg of Paris, Voltolini of Breslau, and especially by Wilhelm Meyer of Copenhagen, the discoverer of adenoid vegetations of the naso-pharynx (" adenoids "), who recognized the great importance of this disease and gave an inimitable account of it in the Trans. of the Royal Medical and Chirurgical Society of London, 187o, and the Archiv fur Ohrenheilkunde, 1873 .

Adenoid vegetations, which consist of an abnormal enlargement of Luschka's tonsil in the vault of the pharynx, frequently give rise to ear disease in

children, and, if not attended to, lay the foundation of nasal and ear troubles in after life . They are often associated with enlargement of the faucial tonsils . Journals.—In 1864 the Archiv fur Ohrenheilkunde was started by Politzer and Schwartze, and, in 1867, the Monatsschrift .fur Ohrenheilkunde (a monthly publication) was founded by Voltolini, Gruber, Weber-Liel and Rudinger . Appearing first as the Archives of Ophthalmology and Otology, simultaneously in English and German, in 1869, the Archives of Otology became a separate publication under the editorship of Knapp, Moos and Roosa in 1879 . Amongst other )ournals now existing are Annales des maladies de l'oreille et du larynx (Paris), Journal of Laryngology (London), Centralblatt fur Ohrenheilkunde (Leipzig), &c . Societies.—The earliest society formed was the American Otological Society (1868), which held annual meetings and published yearly transactions . Flourishing societies for the study of otology (sometimes combined with laryngology) exist in almost all civilized countries, and they usually publish transactions consisting of original papers and cases . The Otological Society of the United Kingdom was founded in 1900 . International Congresses.—International Otological congresses have been held at intervals of about four years at New York, Milan, Basel, Brussels, Florence, London and Bordeaux (1904) . The pro-.ceedings of the congresses appear as substantial volumes . Hospitals.—The earliest record of a public institution for the treatment of ear diseases is a Dispensary for Diseases of the Eye and Ear in London, started by Saunders and Cooper, which existed in 1804; the aural part, however, was soon closed, so that the actual oldest institution appears to be the Royal Ear Hospital, London, which was founded by Curtis in 1816 . Four years later there was started the New York Eye and Ear Infirmary .

At the present time in every large

town of Europe and America ear diseases are treated either in separate departments of general hospitals or in institutions especially devoted to the purpose . For a history of otology from the earliest times refer to A Practical Treatise on the Diseases of the Ear, by D . B . St John Roosa, M.D., LL.D . (6th edition, New York . 1885). and for a general account ofthe present state of otological science to A Text-Book of the Diseases of the Ear for Students and Practitioners, by Professor Dr Adam Politzer, transl. by Milton J . Ballin, Ph.B., M.D., and Clarence J . Heller, M.D . (4th edition, London, 1902) . (E . C .