Popular Science Monthly/Volume 42/December 1892/Deafness, and the Care of the Ears
| DEAFNESS, AND THE CARE OF THE EARS. |
By ABRAM MILLS FANNING, M. D.
IT is astonishing to realize how little is known by the laity of the simplest rules for the preservation of health.
It would be amusing if it were not so shocking, because so ignorant, to know of some of the curious remedies used by people otherwise intelligent. Owing to this widespread, dense ignorance of simple medical facts among our people, positive harm is done, irreparable in many instances.
Our blind asylums contain many cases of what are known to physicians as cases of "preventable blindness"—the sight forever destroyed by the use of some "old woman's remedy," as tea-leaves, for instance, persisted with until damage too great to be successfully combated by the physician is done to the sight.
It is the popular idea that the deaf and dumb are always born with that affliction. Of course it is not so. As a rule, there is no radical defect of the organs of phonation; but children born deaf can not talk because they have never heard and learned any words. Many are the children, blessed with perfect hearing and consequent speech for the first two, three, or four years of their lives, who, in consequence of improper or no attention to their ears during an attack of measles, scarlet fever, or diphtheria, have totally lost all sense of hearing; and their ability to talk has then gradually diminished and disappeared also. Our deaf and dumb asylums are filled with just such cases of "preventable deafness."
This popular ignorance of ordinary medical truths can be attributed in great part to the disinclination of reputable physicians to write popular articles for the enlightenment of general humanity. Most of what has been written of a medical nature for the general reader has been confined to advertisements of patent medicines.
Probably the two most important senses are those of seeing and hearing; and it is of these same two that the least is known by the general public, and that the greatest number of absurdly ridiculous, dangerously improper popular remedies are used. It is the purpose of this writing to correct in some measure this misconception in regard to the ears.
A recent experiment was made by the writer at one of our large eye and ear hospitals in this city to obtain some approximate idea of the proportion of people who really have perfect hearing among those who believe themselves exempt from any defect of the auditory apparatus. Without previous warning, twenty-five eye patients were selected, care being taken to have none but those who had never suffered from any, even temporary, defect of hearing. Of the twenty five, not more than five could be said to enjoy perfect hearing. Four fifths of the patients tested had impaired hearing, and had never suspected any defect whatever.
Of all the native-born inhabitants of New York and vicinity and of residents who came here in early life before their respiratory passages were fully developed, probably a not very much smaller percentage have lost some of their ability to hear perfectly.
The normal ear is capable of hearing considerably better than is necessary for the ordinary purposes of civilization; in fact, is endowed with what may be termed "superfluous hearing." Proper tests will discover the loss of even a small portion of this superfluous hearing, and warn us that we are gradually becoming deaf—in fact, already partially deaf—although we may not have noticed the slightest deficiency. This explains why it is that many victims of certain forms of chronic deafness believe their complaint to have been sudden in its beginning, when in reality it has been progressing for several years; the longer time having been occupied by the gradual loss of the "superfluous hearing," and the patient's attention not having been directed to his affliction until the "necessary hearing" was encroached upon.
The great majority of all forms of deafness are dependent upon and directly resultant from affections of the nose and throat.
In the city of New York and vicinity, owing to the extreme variations of the temperature and climate from day to day, it is indeed a rarity to find among the people who have lived here any time a perfectly healthy nose and throat. Such repeated sudden extremes of hot and cold damp weather, which are so common in this location, are ruinous to the throats of even temporary visitors with perfectly healthy respiratory organs; and the effect is so marked, the condition so universal among the inhabitants of this city, that children of catarrhal parents are born with a swollen, catarrhal condition of the inside of the nose and throat which within very few years closes the nostrils so that proper respiration is impossible, and the child becomes what physicians call a "mouth-breather." We meet these children constantly in the streets. The climate of Brooklyn is even worse in this respect.
From the condition of a "mouth-breather" it is but a short step to one of two results—more often both: deafness, and that peculiarly stupid, sleepy, inane, foolish expression of countenance so characteristic of the "mouth-breather."
To parents who have the welfare of their children at heart, such a warning as this should be of sacred importance. As soon as the child gives evidence of a tendency to breathe constantly through its mouth, just so soon should intelligent medical investigation be made of its nostrils, preferably by a proper specialist.
It is quite common for a child's mouth to drop open when asleep, although he may have been breathing through his nose when falling asleep. To correct this tendency it has long been a custom among many mothers to tie a folded handkerchief over the child's head and under its chin to keep the mouth closed. But it is cruel and dangerous to do this unless we are positive that the child can breathe easily through the nose.
Snoring also should be a warning, because snoring is usually due to breathing through the mouth, and mouth-breathing is due to the swollen, catarrhal condition of the inside of the nose; and it is this condition which is the cause of dry catarrhal deafness, which is by far the most frequent form of deafness.
Most of our population have some general ideas of catarrhal affections of the nose and throat, but very few except those who have lost their hearing from it have any conception of its intimate causal relation with deafness. The popular idea of catarrh is that it is a condition of more or less constant discharge of offensive mucus from the nose. This is so only in the most aggravated and worse forms of the disease, and fortunately is rare. Properly speaking, catarrhal affections of the nose and throat are simply an enlarged, swollen, and thickened condition of the lining membrane of the nostrils and back part of the throat. This thickened condition of the mucous membrane in the nose is usually accompanied by an increased production of mucus, which often drops backward into the throat, and, by increased moisture in the back of the throat, excites the continuous little hacking cough to dislodge it and clear the throat.
These patients are very subject to what are called "colds in the head," with complete closure of the nasal passages. The reason their colds in the head are so severe is because a very slight swelling of the inside of the nostrils, which is always, the condition in this acute disease, occurring in a nose already much narrowed by a chronic permanent enlargement of its lining membrane, totally obstructs the nasal canals.
A very common but unhealthy remedy for temporary or permanent occlusion of the nose is to snuff a solution of salt and water through the nostrils. Unfortunately, this practice has been too often thoughtlessly recommended by family physicians. If the habit is prolonged, the condition for which it is used will surely be aggravated. A much better solution to use in the nose, and also as a gargle in acute sore throat, instead of chlorate of potassium, is common baking soda (bicarbonate of soda), a teaspoonful in a cup of warm water. Whatever solution is used in the nose, it is a great mistake to forcibly snuff it into the nostrils from the palm of the hand, as is too commonly done. If it is snuffed too forcibly, it is forced into the upper part of the nasal cavity, where it is very irritating, often causing headache and irritation of the eyes. The best and simplest way to use the soda solution is to bury the nose entirely in the cup of fluid, and then gently suck the solution into the nose, at the same time holding the mouth widely open. There is no risk of choking if the mouth is open and the head thrown forward, as it necessarily is in doing this, for all the fluid will run out through the mouth. A few trials will readily demonstrate the advantage of this method over all others.
Probably all the laity, so to speak, when first they realize that their hearing is diminished, believe that the wax has accumulated and has blocked the auditory canal. The sensation to them is certainly one of obstruction, and they seem justified in picking at the canal of the ear in attempting to remove the obstructing substance.
With very rare exceptions, deafness is never due to wax alone. In the majority of cases it is really due to obstruction, but this is very much farther in the head than any patient can reach, and often of too dense a nature and too long duration for even the specialist in otology to successfully eradicate. Even where there certainly exists a mass of wax entirely blocking the auditory canal, with it is always associated an underlying catarrh of the drum of the ear without any discharge from the ears whatever. The effect upon the hearing is like that caused by closure of the canal, and wax alone is suspected. In the effort to remove the suspected obstruction, matches, toothpicks, hair-pins, etc., are used in the ears, and perhaps a little of the normal wax which belongs in the canal is removed, and the patient's suspicion seems to be verified.
It must be emphasized right here that the ear-scoops and ear-sponges for sale in all drug-shops are worse than useless; they are positively dangerous. Many are the ears that have been incurably injured by such instruments. There is more wisdom than humor in the old saying that we ought to put nothing in our ears but our elbows. At any rate, let no one put anything into the auditory canal but the end of the little finger wrapped with a handkerchief or a towel.
If deafness is of sudden occurrence, accompanied by a dull, rumbling sound in the ear, similar to that caused by temporarily closing the canal of the ear by the finger, with a sensation of fullness of the canal, and absolutely painless, obstruction from accumulated wax may be suspected. But there is no means of positively determining this, except by having the ear carefully examined by some competent observer.
To remove impacted wax, the same baking soda (bicarbonate of soda) is the best preparation to use. A teaspoonful of the soda should be mixed with just enough warm water to dissolve it; this should then be dropped into the ear until it is filled, and allowed to remain in contact with the wax for five or ten minutes. It is to be repeated three times during the day; and then the ear should be thoroughly syringed with a quart of hot water. No other syringe than the fountain douche should be used.
For ordinary purposes a good douche can be extemporized from an old quart bottle by attaching a convenient length of rubber tubing to its mouth, and, filling the bottle full of the hot water, invert it and allow the water to flow through the tubing into the ear.
Other forms of deafness are too deeply seated to be dealt with by any one but a specialist.
The earliest symptom of beginning deafness in many cases is a ringing sound in the ears. Many patients describe it as a noise all through the head rather than in the ear itself. It is at first intermittent and occasional. The ringing may be present for some time, scarcely perceptible, when suddenly the sound will change, becoming much louder, and the note jumping high up in the scale, where it will continue to ring quite loudly for some minutes, and gradually die away, to appear again some time afterward. It may reappear in a few hours, as the trouble with the ears progresses. Ringing in the ears may also be the prelude to an acute attack of earache; but it is here followed very soon by pain, which so predominates over the ringing that it is no longer heard.
If the hearing is properly tested just as soon as the ringing in the ears has become more or less constant, some degree of deafness will be detected. As the case progresses, even before all the so-called superfluous hearing has been destroyed, the patient will realize that he is becoming deaf. For this condition there is nothing to be done by the patient himself. Advice from a physician should be obtained just as soon as diminution of hearing is suspected.
Much can be accomplished, however, by the patient toward preventing the deafness becoming worse. Careful attention should be devoted to the general health, to keep the nose and throat in as healthy condition as possible—to prevent "taking cold," especially colds in the head. Exposure to changes of weather should be avoided; the feet never being allowed to become wet, or, if they do become wet, the shoes and stockings should be changed for dry ones as soon as possible. Turkish baths and plenty of outdoor exercise are strongly to be recommended, to stimulate the circulation and inure the system to changes of weather.
Another great class of troubles which is sadly misunderstood by the public is the acute inflammations of the ear. There are few pains in the human body more distressing than earaches. Many have been the nights of agony passed with pain in the ear, because the proper remedy has not been known in the household.
Almost every conceivable thing has been used for earache by patients of high and low degree. With the exception of baking soda, already mentioned—and I have considerable hesitancy in trusting even that to popular use—nothing should ever be dropped in the ear except hot water. When the ear is throbbing with pain, the hot douche is the best means to employ for relief. In this condition any kind of a syringe is available, for there is not much probability of the sufferer throwing a stream forcible enough to increase his pain. Very hot water should be used. A quart of plain water as hot as can be endured should be injected, repeating it as often as is necessary—every five minutes, even.
If we happen to be beyond the reach of a physician, and the hot-water douche fails to relieve, leeching should be employed, remembering to apply the leech upon the little projection just in front of the ear, called the tragus. Do not ever put a poultice over the ear.
To secure rest at night and between the intervals of necessary douching, fill the auditory canal with hot water, cover the whole side of the head with a napkin wrung out in hot water, and tie a dry towel over the entire head.
Simple tenderness in front of the external ear or in the canal means either a pimple or a boil in the canal. In this condition also, hot douching and hot-water applications are the only safe remedies to employ at home. Medical advice must be sought early, to open the little abscess and allow the matter to escape.
Violent, throbbing, deep-seated earache means an abscess within the drum cavity of the ear; and this is a serious disease—often ruinous to the hearing, and even dangerous to life. The advice of a physician, preferably a specialist, is indispensable; and the above hints are not at all intended to supply his place, but merely to anticipate his arrival.