Skip to main content

Full text of "Diseases Of The Nose Throat And Ear"

See other formats

310                                           THE EAR


Chronic tubal obstruction has many causes, originating either at the tympanic
or the pharyngeal end of the tube, which produce hyperplastic thickening,
adhesions or strictures but in a number of cases no abnormality is present
in these areas or it has previously been eliminated. In such cases repeated
infections, often accompanied by otitis media, have caused thickening of the
tubal lining and consequent obstruction. Rarely congenital stenosis or other
anatomical abnormality gives rise to obstruction.

Chronic salpingitis produces conductive deafness described as a blocked
or stuffy feeling in the ear with a variable amount of discomfort. The patient
cannot clear the ear by auto-inflation (Valsalva's manoeuvre) although
catheterization may inflate the ear with improvement in hearing which
is not maintained for more than a few hours.

On examination the characteristic feature is retraction of the drumhead
in whole or in part. Retraction of the membrana tensa is seen when the
handle of the malleus appears shortened and lies in a more horizontal
position, the lateral process of the malleus is prominent and the cone
of light is absent (see Plate X, 2). Partial or localized retraction may
involve any segment of the drumhead but often produces an appearance
in which the membrane is draped over the incudo-stapedial joint or appears
to adhere to and outline the promontory of the middle ear. On catheteriza-
tion of the tube the sounds heard on auscultation differ from the soft blowing
murmur heard with a normally patent tube.

TREATMENT. In the majority of patients treatment of this condition provides
only temporary relief. Periodical catheterization and inflation is usually
practised despite its short-term benefit. At the pharyngeal end of the tube
any factors predisposing to infection should be treated. The insertion of a
grommet may be required in cases with recurrent middle ear exudate, and
the prescription of a hearing aid is necessary in those patients whose deafness


An unduly open Eustachian tube is sometimes associated with atrophic
changes in the mucous membrane of the nose and pharynx. The mucosa of
the whole tube may be affected or changes may be limited to the pharyn-
geal opening. It may occur in elderly patients particularly those with debili-
tating diseases and marked weight loss. Congenital abnormality may account
for a small number of cases.

Patients suffering from this condition complain of the loudness or reson-
ance of their own voice (autophony) whilst their hearing is reduced for
other voices and sounds. They may be aware of their own breath sounds
and the patient's breathing can be heard through an auscultation tube. On
examination the characteristic sign is the inward and outward movements
of the drumhead accompanying respiration.

TREATMENT. In patients suffering from atrophic conditions of the nose
and pharynx measures appropriate to the treatment of those diseases should
be employed. Elderly and debilitated patients may benefit from attention
to their general health and correction of dietary deficiencies. The insertion