Diseases Of The Nose Throat And Ear

CHAPTER 49
SYMPTOMS OF EAR DISEASE

The most common symptoms referable to the ear are deafness, discharge
from the ear, pain, itching, tinnitus and giddiness. In addition to these there
may be symptoms indicating invasion of the labyrinth or of the intracranial
contents by disease. Spontaneous nystagmus, loss of coordination and balance,
vomiting, headache, rigors and disturbances of the pulse and temperature are
clinical features of graver import. In taking a history the presence or absence
of the common symptoms should be ascertained and their duration noted. In
ail investigations of aural conditions the examination must include that of the
pharynx, nasopharynx and nose.

Deafness. Deafness is the most common symptom of ear disease, and it may
vary from a degree so slight as to escape the notice of the patient to complete
loss of hearing. Certain anomalies of hearing sometimes accompany the
deafness. In cases of middle ear deafness the patient may hear better in a
noise, as for example when travelling in a train or a bus, and in some instances
he appears to hear better than normal individuals in these conditions. This is
called paracusis, and is found most typically in otosclerosis. The sudden onset
of deafness may be due to a blast injury, a plug of wax in the meatus or to an
acute otitis with effusion into the middle ear cavity. Deafness of gradual
onset is met with in otosclerosis and in the arteriosclerotic deafness of old
people. In other instances hyperacusis is met with, that is, the sensation of
pain on exposure to loud, and especially shrill, noises. Much more rarely the
patient complains of diplacusis, the same tone being heard as notes of a
different pitch by the right and the left ears. Needless to say this condition is
usually complained of by musical people.

Discharge. Discharge from the ear may arise from the external meatus or
the middle ear cavity. The discharge varies in type. Some patients aver that
their ear is running when the discharge is of wax. Aural discharge may be
thick and composed mainly of epithelial debris and contains no mucus. This
arises from the meatal walls. If pus is mixed with the epithelial debris, and if
mucus is absent, the cause is probably an otitis externa. A profuse thin serous
discharge which irritates the skin of the meatus and the auricle is found in a
certain type of external otitis. There are no mucus-secreting glands in the
external meatus and therefore if there is no mucus in the discharge, the cause
is likely to be in the outer ear. Mucus is recognized by its tenacious adherence
to a wool mop. Discharge from the middle ear may be mucopurulent, purulent
or epithelial in nature. An acute otitis media which erupts through a perfora-
tion gives rise to a purulent or mucopurulent discharge which may exhibit
pulsation. A chronic otitis media through a central perforation results in a
mucopurulent discharge, while a chronic otitis media with an attic or marginal
perforation causes a scanty discharge of pus and epithelial debris. The

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