Leading articles.

Injuries of the Ear Drum.

W. S. CARTER, M. D., JACKSON, MISSISSIPPI

While the surgical conditions which affect the ear, whether they be traumatic, or the result of other disease, are now treated almost exclusively by specialists, the most of these at some time or other are brought to the attention of the busy practitioner. I have thought that the history of a few accidents which affect the ear might not be other than valuable to the readers of this journal.

Injuries to the typanum from violence are quite common in the practice of every physician. In many cases the results are not serious, but in so many cases they are of such importance that they should be well understood.

The effect of violent noises or sharp sounds are as common, perhaps, as any other one injury. During the late war of the rebellion a large number of cases were observed, which illustrate this class. A private in the battle of Gettysburg was stunned by the explosion of a shell at his left. Subsequent examination showed a rent in the drum of the left ear, from which he never recovered.

A few days after the accident, a thin discharge from the ear was noticed, which afterward became purulent, accompanied by an offensive odor. The soldier suffered so constantly from tinnitus aureum that he was at one time on the verge of insanity. He compared the sound to that of the steady escape of steam from an exhaust pipe.

In a fourth of July celebration, a man previously in good health, with perfect hearing, had a pistol discharged close to his ear. There was a slight shock and some pain, but no evidence of actual injury until the next day, when the ear discharged a bloody pus, which continued to flow for a long time. There was a severe tinnitus for a few months, when it ceased spontaneously. There was a rupture of the drumhead in this case also. Deafness did not immediately occur, but ultimately followed.

There is not so much injury to the ear drum when the canal is tortuous and narrow, as when it is wide and straight. The position of the sound producing cause, is also important. If the individual be on either side of the cause, or if the concussion occurs in front of him, the danger is much greater than if it occurred behind him.

The injury is not always produced by the air being driven into the ear, but may be caused by the air being suddenly withdrawn from it by the violent air currents resulting from explosion.

An engineer, standing with his right ear near an open window in his cab, while going at a great speed against a strong wind, blew the engine whistle at full blast. There was a violent shock, a severe pain, followed by vertigo and nausea. These symptoms slowly disappeared; then there appeared a discharge from the ear, which also disappeared, but there remained a permanent impairment of the hearing. The drumhead in this case was found to be ruptured also.

A young lady (in play) surrounded, with both hands, one of the ears of a young lady friend, who was lying on a sofa with her face to the wall, and screamed into the ear. The victim of this joke put both hands to her face, uttered a shriek and then fainted. Coming to herself, she was troubled with tinnitus, which affected her much like the ringing of bells. These symptoms left her in a few days, but there was an impairment of the hearing, which manifested itself in a recurrent deafness, from which she eventually recovered.

A common cause of deafness among children is from blows received on the side of the head, generally upon the ears. "Boxing" of the ears has probably been a popular method of punishment from time immemorial. It is convenient and effectual, but it is heathenish and brutal. Pulling of the ears is also a source of injury, which may be more or less severe than that produced by ear-boxing.

There is the report of the case of a woman who received a blow upon the right ear from the fist of a man. The first effect was severe dizziness; this symptom grew so strong that she became alarmed at the extreme pain and autophonia. She received some treatment, but it served only to increase the pain.

Visiting an infirmary, she was examined, and the ear drum was found to be ruptured. There was a continual and excessive flow of serous matter from the ear, which was diagnosed as water from the labyrinth, it having also been ruptured by the blow. She became intensely nervous, and experienced hallucinations and delusions. Purulent inflammation of the middle ear set in, and this ran a severe course. The injury not only affected the ear, but the brain also, as the symptoms indicated.

G., age fourteen, was struck with some force upon the ear by an open hand. Severe inflammation of the middle car soon followed the perforation of the drumhead, which was the direct result of the blow. There was permanent deafness in this case, and there was present the peculiar whistling sound of the air, passing through the rent, which is observed in many cases.

There are a number of cases in the records of the courts where action has been taken for damages—for injuries resulting from similar causes. Many a careless school teacher has been justly called to pay a severe penalty for this inhuman manner of punishment. One of the professors in Columbia College at one time was sued for large damages because of injuries inflicted by the kind of punishment above described.

The history of a peculiar and interesting case came to the writer's knowledge, wherein an infatuated young man kissed his sweetheart so violently in the ear that pains and vertigo immediately resulted therefrom. Soon afterward a muco-purulent discharge began, and an examination disclosed a rupture of the ear drum. Hearing was impaired in this case, it being more or less permanent, and for a long time there was occasional deafness.

A number of cases are on record where the patients have been struck by rocks, balls, or clubs, and various other things, upon the external ear, causing injury to the drum—such as falls from carriages, falls to the pavement, or on the ice, by slipping, falling down stairs, falling from a chair, stepladder, or other short distances.

Such cases are attended by pain, tinnitus, vertigo, all more or less prominent, often fainting; a discharge from the ear—first of blood, afterward of pus—usually is present, although sometimes it is not. Deafness is not necessarily present, although it is most frequently so. Sometimes there is ringing, as of bells, other times explosive sounds.

Where there are strong evidences of perforation of the drum head, the physician, unless he be a specialist, should refrain from internal treatment, such as injections, cotton plugs, or oil. If medicines are indicated administer them, but leave the treatment of the internal ears to experts.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.