Popular Science Monthly/Volume 3/June 1873/The Hygiene of the Ear

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THE HYGIENE OF THE EAR.
By JAMES HINTON,
AURAL SURGEON TO GUY'S HOSPITAL, LONDON.

IT is natural that we should regard with an intense curiosity all the faculties with which our bodily frame is gifted, and that we should desire to preserve them as perfectly as possible. The following remarks are designed to do something toward gratifying that curiosity with regard to one of the most important of our powers, and to give a few hints in respect to things that are hurtful to it.

Our popular physiologies teach us that there is a tube leading from the drum of the ear into the throat, called, from its discoverer Eustachius, the "Eustachian tube." The use of this tube is twofold. First, it supplies the drum with air, and keeps the membrane exactly balanced, and free to move, with equal air-pressure on each side; and, secondly, it carries off any fluid which may be in the drum, and prevents it from being choked by its own moisture. It is not always open, however, but is opened during the act of swallowing, by a little muscle which is attached to it just as it reaches the throat. Most persons can distinctly feel that this is the case, by gently closing the nose and swallowing; when a distinct sensation is felt in the ears. This sensation is due to a little air being drawn out of the ears through the open tube during swallowing; and it lasts for a few minutes, unless the air is again restored by swallowing with the nose unclosed, which allows for the moment a free communication between the ear and the throat. We thus see a reason for the tube being closed. If it were always open, all the sounds produced in the throat would pass directly into the drum of the ear, and totally confuse us. We should hear every breath, and live in a constant bewilderment of internal sounds. At the same time the closure, being but a light contact of the walls of the tube, easily allows a slight escape of air from the drum, and thus not only facilitates and regulates the oscillations of the air before the vibrating membrane, but provides a safety-valve, to a certain extent, against the injurious influence of loud sounds.

The chief use of the Eustachian tube is to allow a free interchange of air between the ear and the throat, and this is exceedingly important; and it is very important also that its use in this respect should be understood. Persons who go down in diving-bells soon begin to feel a great pressure in the ears, and, if the depth is great, the feeling becomes extremely painful. This arises from the fact that in the diving-bell the pressure of the air is very much increased, in order to balance the weight of the water above; and thus it presses with great force upon the membrane of the drum, which, if the Eustachian tube has been kept closed, has only the ordinary uncompressed air on the inner side to sustain it. It is therefore forced inward and put upon the stretch, and might be even broken. Many cases, indeed, have occurred of injury to the ear, producing permanent deafness, from descents in diving-bells, undertaken by persons ignorant of the way in which the ear is made; though the simple precaution of frequent swallowing suffices to ward off all mischief. For, if the Eustachian tube is thus opened, again and again, as the pressure of the outside air increases, the same compressed air that exists outside passes also into the inside of the drum, and the membrane is equally pressed upon from both sides by the air, and so is free from strain. The same precaution is necessary in ascending mountains that are lofty, for then there is the same effect of stretching produced upon the membrane, though in the opposite way. The outside air becoming less and less condensed as a greater height is gained, the ordinary air contained within the drum presses upon the membrane, which is thus insufficiently supported on the outside, and a similar feeling of weight and stretching is produced. The conjurer's trick of breaking a vase by a word rests on the same principle. The air is exhausted from within, and the thin, though massive-looking sides of the vase collapse by the pressure of the air outside; and, just as ever so small a hole, made at the right moment in the side of the vase, would prevent the whole effect, so does swallowing, which makes a little hole, as it were, for the moment in the drum of the ear, prevent the in-pressing or out-pressing of the membrane. Mr. Tyndall, in his interesting book "On Sound," tells us how he employed this precaution of swallowing, and with entire success, when, in one of his mountain excursions, the pressure on his ears became severely painful.

Deafness during colds arises very often, though not always, from a similar cause. For, when, owing to swelling of the throat, the Eustachian tube cannot be opened by its muscle, and so the air in the drum is not renewed, the air that is contained in it soon diminishes, and the outer air presses the membrane in, so that it cannot vibrate as it should. This is what has been sometimes called "throat-deafness."

There are several things very commonly done which are extremely injurious to the ear, and ought to be carefully avoided. Those who have followed the previous description will easily understand the reason.

And first, children's ears ought never to be boxed. We have seen that the passage of the ear is closed by a thin membrane, especially adapted to be influenced by every impulse of the air, and with nothing but the air to support it internally. What, then, can be more likely to injure this membrane than a sudden and forcible compression of the air in front of it? If any one designed to break or overstretch the membrane, he could scarcely devise a more effective means than to bring the hand suddenly and forcibly down upon the passage of the ear, thus driving the air violently before it, with no possibility for its escape but by the membrane giving way. And far too often it does give way, especially if, from any previous disease, it has been weakened. Many children are made deaf by boxes on the ear in this way. Nor is this the only way: if there is one thing which does the nerve of hearing more harm than almost any other, it is a sudden jar or shock. Children and grown persons alike may be entirely deafened by falls or heavy blows upon the head. And boxing the ears produces a similar effect, though more slowly and in less degree. It tends to dull the sensibility of the nerve, even if it does not hurt the membrane. I knew a pitiful case, once, of a poor youth who died from a terrible disease of the ear. He had had a discharge from it since he was a child. Of course his hearing had been dull: and what had happened was that his father had often boxed his ear for inattention! Most likely that boxing on the ear, diseased as it was, had much to do with his dying. And this brings me to the second point. Children should never be blamed for being inattentive, until it has been found out whether they are not a little deaf. This is easily done by placing them at a few yards' distance, and trying whether they can understand what is said to them in a rather low tone of voice. Each ear should be tried, while the other is stopped by the finger. I do not say that children are never guilty of inattention, especially to that which they do not particularly wish to hear; but I do say that very many children are blamed and punished for inattention when they really do not hear. And there is nothing at once more cruel and more hurtful to the character of children than to be found fault with for what is really their misfortune. Three things should be remembered here: 1. That slight degrees of deafness, often lasting only for a time, are very common among children, especially during or after colds. 2. That a slight deafness, which does not prevent a person from hearing when he is expecting to be spoken to, will make him very dull to what he is not expecting; and, 3. That there is a kind of deafness in which a person can hear pretty well while listening, but is really very hard of hearing when not listening.

The chief avoidable cause of deafness is catching cold, and whatever keeps us from colds helps us to preserve our hearing. We should do, therefore, those things that help to keep colds away: for which the first is taking plenty of fresh air; the second using enough, but not too much, cold water all over us, taking especial care to rub ourselves thoroughly dry, and never to let it chill us; and the third is to avoid draughts, and wet, especially sitting in wet clothes, or being in close or very heated rooms. But there are some kinds of cold especially hurtful to the ear. One is sitting with the ear exposed to a side wind, as too many people do now on the roofs of omnibuses, and so on. We should always face the wind; then, if we are not chilled, it is hard to have too much of it. Another hurtful thing is letting rain or sleet drive into the ear, against which, if it were not that people do sometimes suffer from this cause, it would seem as if it could hardly be necessary to caution them.

Another source of danger to the ear, however, arises from the very precautions which are sometimes taken against those last mentioned. Nothing is more natural than to protect the ear against cold by covering it by a piece of cotton-wool; and this is most useful if it is done only on occasions of special exposure, as when a person is compelled to encounter a driving storm, or has to receive on one side of the head the force of a cutting wind. But it is astonishing in how many cases the cotton-wool thus used, instead of being removed from the ear when the need for it has passed, is pushed down into the passage, and remains there, forming itself an obstruction to hearing, and becoming the cause of other mischiefs. Three separate pieces have sometimes been found thus pushed down, one upon the other. Paper rolled up, which is also used for protecting the ear when cotton-wool is not at hand, is still more irritating when it is thus left unremoved. The way to avoid this accident, besides being careful not to forget, is to use a large piece of wool, and to place it over, rather than in, the passage.

It should be remembered that constantly covering up the ear is adapted to injure it. On the whole, men in whom the ear is habitually exposed, suffer if any thing less from ear-disease than women, in whom it is so often covered. Nor can the "hat" be held an unsafe head-dress in this respect for the latter sex. But it is important that there should not be frequent changes, especially in cold weather, from a head-dress which covers to one which exposes the ear. It is better that the air should always have free access to it; but if this has not been the case, the summer should be chosen to make the change.

All sorts of substances are sometimes put into the ear by children, who do it to themselves or to each other in ignorant play. If every parent and teacher warned his children against doing this, it would not be a useless precaution. When the accident happens, the chief danger is that of undue haste and violence. Such bodies should be removed by syringing with warm water alone, and no attempt should be made to lay hold of them or move them in any other way. It is enough to reflect, again, that the passage of the ear is closed by a delicate membrane to show the reason for this rule. When no severe pain follows, no alarm need be felt. It is important that the substance should be removed as speedily as is quite safe, but there need never be impatience; nor should disappointment be felt if syringing needs to be repeated on many days before it effects its end. It will almost invariably succeed at last in the hands of a medical man, and is most effective if the ear is turned downward and syringed from below.

Now and then an insect gets into the ear and causes great pain; the way to get rid of it is to pour oil into the ear. This suffocates the insect.

There is another danger arising from boyish sports. Snowballs sometimes strike the ear, and the snow remaining in it sets up inflammation. This danger is increased by a practice which should be inadmissible, of mixing small stones with the snow, which thus effect a lodgment in the ear.

Among the causes of injury to the ear must unfortunately be reckoned bathing. Not that this most healthful and important pleasure need, therefore, be in the least discouraged; but it should be wisely regulated. Staying too long in the water certainly tends to produce deafness as well as other evils; and it is a practice against which young persons of both sexes should be carefully on their guard. But, independently of this, swimming and floating are attended with a certain danger from the difficulty of preventing the entrance of water into the ear in those positions. Now, no cold fluid should ever enter the ear; cold water is always more or less irritating, and, if used for syringing, rapidly produces extreme giddiness. In the case of warm water its entrance into the ear is less objectionable, but even this is not free from disadvantage. Often the water lodges in the ears and produces an uncomfortable sensation till it is removed: this should always be taken as a sign of danger. That the risk to hearing from unwise bathing is not a fancy, is proved by the fact, well known to lovers of dogs, that those animals, if in the habit of jumping or being thrown into the water, so that their heads are covered, frequently become deaf. A knowledge of the danger is a sufficient guard. To be safe it is only necessary to keep the water from entering the ear. If this cannot be accomplished otherwise, the head may be covered. It should be added, however, that wet hair, whether from bathing or washing, may be a cause of deafness, if it be suffered to dry by itself. Whenever wetted, the hair should be wiped till it is fairly dry. Nor ought the practice of moistening the hair with water, to make it curl, to pass without remonstrance. To leave wet hair about the ears is to run great risk of injuring them. In the washing of children, too, care should be taken that all the little folds of the outer ear are carefully and gently dried with a soft towel.

But I come now to what is probably the most frequent way in which the ear is impaired: that is, by the attempt to clean it. It ought to be understood that the passage of the ear does not require cleaning by us. Nature undertakes that task, and, in the healthy state, fulfils it perfectly. Her means for cleansing the ear is the wax. Perhaps the reader has never wondered what becomes of the ear-wax. I will tell him. It dries up into thin fine scales, and these peel off, one by one, from the surface of the passage, and fall out imperceptibly, leaving behind them a perfectly clean, smooth surface. In health the passage of the ear is never dirty; but, if we attempt to clean it, we infallibly make it so. Here—by a strange lack of justice, as it would seem, which, however, has no doubt a deep justice at the bottom—the best people, those who love cleanliness, suffer most, and good and careful nurses do a mischief negligent ones avoid. Washing the ear out with soap and water is bad; it keeps the wax moist when it ought to become dry and scaly, increases its quantity unduly, and makes it absorb the dust with which the air always abounds. But the most hurtful thing is introducing the corner of the towel, screwed up, and twisting it round. This does more harm to ears than all other mistakes together. It drives down the wax upon the membrane, much more than it gets it out. Let any one who doubts this make a tube like the passage, especially with the curves which it possesses; let him put a thin membrane at one end, smear its inner surface with a substance like the ear- wax, and then try to get it out so by a towel! But this plan does much more mischief than merely pressing down the wax. It irritates the passage, and makes it cast off small flakes of skin, which dry up, and become extremely hard, and these also are pressed down upon the membrane. Often it is not only deafness which ensues, but pain and inflammation, and then matter is formed which the hard mass prevents from escaping, and the membrane becomes diseased, and worse may follow. The ear should never be cleaned out with the screwed-up corner of a towel. Washing should extend only to the outer surface, as far as the finger can reach.

Ear-picks, again, are bad. If there is any desire to use them, it shows that the ear is unhealthy; and it wants soothing, not picking. And there is another danger from introducing any solid thing into the ear. The hand may get a push, and it may go too far. Many is the membrane that has thus been broken by a bodkin. Sportsmen sometimes have their membrane pierced by turning suddenly while getting through a hedge. And it even happens that a boy at school may put a pen close to another's ear, in play, and call to him to make him turn his head; and the pen pierces the membrane. Very loud sounds may cause deafness, too. Artillerymen, and also eager sportsmen, and very zealous volunteers, incur a danger from this cause. It is well to stop the ears when exposed to loud sounds, if possible; also to avoid belfries when the bells are about to ring. A man who was once shut up in one became stone-deaf before the peal was done. The sound of guns is more injurious to those who are in a confined space with them, and also if the mouth be open. Injury from loud sounds, also, is much more likely to occur if they are unexpected; for, if they are anticipated, the membrane is prepared for them, without our knowledge, by its muscles. At certain points on the Rhine, it is, or was, the custom of the captain of the steamboat to fire a small cannon, to exhibit the echo. When this has been done without due warning, it has proved more than once a cause of lasting deafness. Sometimes these loud sounds rupture the membrane; sometimes they deaden the nerve: the former is the least evil.

It is a bad practice, also, to put cotton-wool soaked in laudanum or chloroform into the ear for the relief of toothache. It may be sometimes effectual, for the nervous connection between the teeth and the ear is very close. But the ear is far too delicate and valuable an organ to be used as a medium for the application of strong remedies for disorders of other and less important parts; and laudanum, and more especially chloroform, is a powerful irritant. The teeth should be looked after in and for themselves, and, if toothache spreads to the ear, that is the more reason for taking them thoroughly in hand; for prolonged pain in the head, arising from the teeth, may itself injure the hearing. When a child's ear becomes painful, as it so often does, every thing should be done to soothe it, and all strong, irritating applications should be avoided. Pieces of hot fig or onion should not be put in; but warm flannels should be applied, with poppy-fomentation, if the pain does not soon subside. How much children suffer from their ears, unpitied because unknown, it would probably wring the hearts of those who love them suddenly to discover. It is often very hard, even for medical men, to ascertain that the cause of a young child's distress is seated in the ear, and frequently a sudden discharge from it, with a cessation of pain, first reveals the secret of a mysterious attack which has really been an inflammation of the drum. The watchfulness of a parent, however, would probably suffice to detect the cause of suffering, if directed to this point, as well as to others. If children cry habitually when their ears are washed, that should not be neglected; there is, most likely, some cause of pain. Many membranes are destroyed from discharges which take place during "teething." Whenever there is a discharge of matter from the ear, it would be right to pour in warm water night and morning, and so at least to try and to keep it clean. But into the treatment of diseases of the ear it would not be suitable to enter here.—Abridged from the People's Magazine.