TUBERCULOSIS AND SYPHILIS OF THE EAR
In the majority of cases there is a reduction of caloric response. In cases of
congenital origin the cerebrospinal fluid is practically always normal, and
the seat of the lesion is therefore most likely in the labyrinth. Both ears
are usually affected and the patients are often deaf-mutes.
DIAGNOSIS. Very profound or complete deafness in a child should suggest
the possibility of congenital syphilis. Suspected cases should be examined
for the presence of interstitial keratitis, 'Hutchinson' teeth, ozaena, saddle-
back nose, perforation of the nasal septum, and scars on the palate, pharynx
Fig. 192. Congenital syphilitic disease of the
ear showing degeneration of Cord's organ in
the basal coil. (Compare with Fig. 143, p. 260.)
Fig. 193. Congenital syphilitic disease of the
ear. Spiral ganglion of the basal coil, showing
atrophy of nerve cells.
and at the angles of the mouth. The patient's mother should be questioned
as to miscarriages and stillbirths. Serological tests for syphilis should be
(1) Primary syphilis of the outer ear is rare. (2) Secondary syphilitic affections
(condylomata and papules) of the external ear and meatus may be associated
with middle ear suppuration.
Secondary syphilis is probably more common than is usually supposed.
Syphilitic nasopharyngitis may spread to the tympanum and give rise to
catarrhal otitis media. The labyrinth is often affected in these cases. As a
rule one ear is involved. The onset of deafness is usually rapid, but the
pain is slight. Tinnitus is marked and giddiness may be present. Inflation
produces no improvement in hearing. Syphilitic otitis media in the tertiary
stage is usually due to an affection of the nasopharynx—gumma or